According to the lesion, the size and nature of surgery (curative or palliative), etc. to determine the site of anastomosis. In the radical resection, subtotal for the esophagus, it often needs to do in the aortic arch of a stomach esophagus anastomosis. But when the tumor is obviously foreign invasion or lymph node metastasis, only relieve symptoms, surgery should be the premise of safe and smooth surgery, esophageal resection should be separated and enough is enough, without wanting to be too broad. Sometimes a lower location of the tumor, although under the agreement may be in the aortic arch, but because of aortic arch obstruction, close to the lower edge of the aortic arch anastomosis operation is often made very difficult match against the bow is more than convenient.
Blood supply of the esophagus above the aortic arch, almost all from the inferior thyroid artery Esophageal branches of the supply of the aortic arch when the need to match, you must cut off the aortic arch above the esophagus, esophageal stump to prevent necrosis due to insufficient blood supply, must not order and stomach easy to fit, to stay too long esophageal adverse consequences.
Esophagogastric anastomosis end to side seam reduction surgery embedded: embedded system consistent with the gastric wall and reduced gastric body parts, can effectively prevent anastomotic desolate and reflux esophagitis, because of the narrowing of intrathoracic stomach can reduce the volume after Respiratory symptoms and pulmonary complications oppression; also simple, easy to master, can shorten the operation time. Esophagogastric anastomosis in the brief are the following
Esophagogastrostomy a. brief surgery to remove the tumor. Esophageal resection in selected parts of a non-invasive clamp folder, and then clamp the distal resection of lesions in the esophagus, the stomach will be free thoracic aortic arch on the plane that do match the above.
b. pulp muscular stomach incision. Select the following 2.5cm at the highest point of gastric anastomosis done, not too close to the greater curvature of stomach, so as not to impede the blood supply. First choose a good area to do a gastric and esophageal anastomosis diameter commensurate transverse incision. Just cut paste muscular, slightly separated incision edges, you can see small blood vessels in the submucosa, one by one on both sides of the blood vessels in the incision with a fine silk suture, and then put on the stomach, ready to esophageal.
c. posterior wall of the outer layer of suture. The posterior wall of the esophagus and gastric stump do the 1st row in front of interrupted 3-4 mattress suture needles, sewing uphill as far as possible, so that sets a longer period of the esophagus into the stomach, the general set of people can be 3-4cm, there valve to prevent the role of gastric reflux. Due to esophageal muscle weak, impatient pull tear easily understood, it is not sewn stitches through muscle and the right side of a sewing needle can be connected with the esophageal subpleural connective tissue on the right side, left a stitch adjacent to the spine and esophagus on the front fascia, the left and right rear between the two pins 1 – 2 sewing needles were connected to the esophageal muscle and connective tissue and mediastinal pleura. Suture should pass through the stomach muscle pulp, but avoid penetrating the mucosa. Suture ligation are first not until all the sutures, the assistant will be put on the stomach, each ligation. Ligation should not be too tight, so as not to tear esophageal wall.
d. appetizer cut open the esophagus. Gauze pad covering the first conservation organizations, following the incision in the stomach muscle on both sides of plasma cut between the suture line of the gastric mucosa, the net absorption of gastric contents, then close to the esophagus to esophageal caught part of the clamp removed. Finally, the esophagus and stomach cut open ends do match.
Esophagogastric anastomosis in the posterior wall of the inner brief e. suture. Corners can be sewn as traction, easy to stomach and esophageal stump accurate incision of the rope, the posterior wall of the inner row 2 full-thickness interrupted or continuous suture. Stitches from the cut edge of the 0.5-0.7cm, to avoid muscle retraction led to suture insufficiency. Stitch spacing is not too dense, not too tight ligation also avoid cutting tissue. Line knot hit the esophagus lumen. This layer suture revealed poor or because of poor visibility due to bleeding, resulting in suture is inaccurate, prone to postoperative anastomotic thin. Therefore, each needle through the stomach or esophagus, it must have been sewn exactly see the mucosa and the mucosa has been working closely on both sides Long, neither gap nor overlap.
f. release a gastric tube. After completion of anastomosis after Bifeng, anesthetists and duodenal tube feeding tube will be pushed down, the surgeon pulled out from the stoma duodenal feeding tube, hung with silk thread at the tip of a diameter of about 1cm of the sugar ball (outside the set of gloves with the fingers of waste, cut a 2-3 hole, easy to dissolve sugar ball and the ball at the anastomosis Jinie sugar will be the introduction of duodenal feeding tube), and then with the tube were into the stomach.
g. the anterior wall of the inner suture. Anterior anastomosis made with fine silk suture inverted interrupted, the line end to play in the cavity, or not inverted, the line hit the outside junction of esophageal and gastric mucosa of rope to be satisfied.
Esophagogastric anastomosis in the anterior wall of the outer brief h. suture. Anastomosis with silk thread through the left and right sides of the stomach, and cut across the corner of mediastinal pleura, but does not seam to wear esophageal muscle, the stomach after ligation of the anastomosis Jibei embedded. Then the ball in the stomach outside the Jinie sugar, nutrition tube into the duodenum.
- esophagogastric anastomosis