Reflux esophagitis, gastric resection, stomach, duodenum, esophagus empty into the intestinal fluid anti-caused inflammation of the esophagus. In particular, most of total gastrectomy and proximal gastrectomy reflux esophagitis caused great suffering to patients.
(1) pathogenesis: There are two, namely, digestive and anti-reflux into the esophagus, fluid discharge delay in the esophagus, the former as the basic factor. The main reasons causing total gastrectomy or proximal gastrectomy, resection of the lower esophageal sphincter responsible for the door, chest muscle legs, chest muscle esophageal ligaments, responsible for such door notch disappeared, resulting in significantly lower esophageal pressure, the formation of reflux . Esophageal fluid discharge delay and smooth the whole gastrointestinal tract is the same. Distal subtotal gastrectomy, line-style building completed the surgery, the door can notch angle Select passivation oblique muscle damage to the stomach, the stomach bubble changes, combined with resection of gastrin secretion in the distal stomach was significantly decreased lower esophageal sphincter pressure drop , resulting in esophageal cleft Temple. Therefore, distal subtotal gastrectomy leaves, can also be found reflux esophagitis.
(2) preventive measures: total gastrectomy or proximal gastrectomy surgical reconstruction of the line of jejunal interposition operation, and anastomotic esophageal side of the remnant stomach and duodenum or asked from anastomotic side should 25_30Cill. Proximal gastric resection, such as esophageal anastomosis, the best blocking gastric stump, gastric remnant esophageal end to side anastomosis, the anastomotic suture parties mentioned in the remnant stomach on the posterior wall of the esophagus to form a "human responsibility door notch." Subtotal gastrectomy side, BI-style redevelopment, duodenum rods should be fully free, the World stomach, duodenum notch after the doors are still capable of preservation responsibility. If patients have a habit of constipation, the cause should be removed, so that stool.
3. Diarrhea does not occur after gastrectomy dumping syndrome, but some patients with chronic diarrhea, intestinal infection is not due.
(1) etiology: a gastric surgical removal of the Select with right node will vagus nerve stem cut off, or expanding the clear perigastric lymph nodes, particularly in clean, damage celiac ganglia and superior mesenteric ganglia (mainly sympathetic, in the same name power pulse around ) and the coverage surrounding the two arteries around the thick nerve bundles. Because these two ganglia, the descending colon and rectum than beam, the dominant way to digest all of the official abdominal extensively damage the ganglion or nerve bundle, then after causing severe diarrhea, leading to malnutrition. Another reason is that most of the whole stomach or gastric resection, or esophageal jejunostomy complete type reconstruction of digestive tract, the duodenum by exclusion, after induction of the food produced film, protein, fat digestion, absorption, causing diarrhea. Nearly half of them are affected by diarrhea in the labor force.
(2) Prevention: Clear the lymph nodes, lymph node metastases and invasion of ganglia, nerve bundles, the doubt should be covered by the nerve tissue around the artery completely removed, or else, usually clear perigastric lymph nodes, on periarterial nerve bundles should be covered be retained. Especially for early gastric cancer surgery straw membrane, in recent years advocated reduction surgery, gastric resection to reduce the vagus nerve stem should be retained. Digestive tract reconstruction, and strive to meet the physiological effect of food by the way, mixing of food and digestive juices, food contact duodenum new film, a variety of digestive enzymes, hormones to be activated, secretion, while increasing the absorption area.
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