Resection according to tumor location and can fit the neck line, chest anastomosis.
Operation as follows: conventional free esophagus and stomach, the cardia cut the esophagus, cardia ends with a Kocher clamp clamp. More than 5cm above the upper edge of esophageal cancer in esophageal anastomosis is expected to do at the 7-silk 4-5 weeks to do all around the esophagus pouch suture needle, the thread under the 3-4cm incision along the longitudinal axis of the esophagus wall about some food 3cm, the nail head into the esophageal cavity slot, purse suture ligation. Necessary, reinforced by the 7th silk ligature, and then use scissors in the bottom 1cm away from the purse suture cut at the esophagus. There are also a scholar with a slotted head screw placement as follows: After the esophagus and the tumor completely free, from the esophagus at the anastomosis site of the proposed line of cut lcm distal esophagus, out of the tumor. 4-pin traction esophageal stump suture line to prevent stump mucosa nail groove retraction and head home to help people. Traction line from the esophageal stump at least 0.8cm margins, in order to prevent tearing the esophagus. Expected to be consistent on the esophagus at the purse to make a full-thickness suture, suture should include esophageal mucosa. Hospital conditions can be used for purse purse suture closure devices. Heger probe with a large vascular clamp article or expansion of esophageal lumen, according to the results of selection of the appropriate expansion of stapler. In general, male patients selected 26mm or 28mm stapler; female patients use 26mm stapler. Then under direct vision into the esophagus to the first nail slot cavity, removal of the traction esophageal stump line, purse suture ligation.
A full stomach and esophageal anastomosis end to side to remove cardia Kocher clamp, net absorption of gastric contents, into the vascular clamp from the cardia (or suture cardia, anterior stoma in the stomach, the vascular clamp inserted), the fundus scheduled anastomosis site pore piercing, vascular clamp to guide the center stapler colostomy rod inserted from the fundus, from the cardia (or stomach anterior wall of the stoma) pulled out, the gastric and esophageal stump completely close.
A full stomach and esophageal anastomosis end to side anastomosis into the center of the main lever machine, tighten the nut back of the main machine, so the main machine and the compression screw slotted head contact, attention between the two can not be too loose or too tight should be the main machine on the subject line of the scale or ruler to check for excess embedded esophageal tissue or adjacent tissue parts to be fit, while the bottom of the stomach of gastric muscle and plasma esophageal anastomosis at the top of the outer membrane and muscular layer interrupted suture one week , temporarily tie.
If the purse suture the edge of the bottom of the esophagus is too long or optional stapler diameter is too small, easily embedded esophageal tissue anastomosis site, and you should release the stapler, the removal of excess tissue, re-trial agreement, where necessary, redo pouch or replacement of major types of suture stapler. If it is found embedded in surrounding tissue anastomosis site, then release the stapler, pulled the surrounding tissue, and then tighten the stapler.
Open the safety button, grip the handle, when the smell and the "click" sound, they cut through anastomosis to complete the anastomosis. Loose nut, gently remove the stapler, and you should absolutely avoid excessive traction anastomosis. Check the stapling of the stomach and esophagus were cut two circular organization is complete, then use the ring clamp live in a small yarn ball from the cardia (or stomach anterior wall of the stoma) to release to the anastomosis, stay out after a while, through the observed whether the blood clot attached to the yarn ball to determine whether the activities of anastomotic bleeding. Proved successful anastomosis, anastomotic circle of pre-ligation suture, and the esophagus to the stomach wall sheath reconstruction of cardiac function and the purpose of preventing reflux, but also to reduce anastomotic tension.
A full stomach and esophagus end to side anastomosis of the stomach and esophagus if that organization does not complete the two ring, according to the site to determine the esophagus is not complete without a full stomach stapled the site, by local full-thickness anastomotic suture anastomosis reinforcement approach. When necessary, even full-thickness interrupted suture anastomosis before the wall, but this method easily lead to postoperative anastomotic stenosis. The assistance of the anesthesiologist, the tube into the stomach, cardia suturing (or stomach anterior wall of the stoma.)
- anastomosis oesophagus
- esophageal gastric anastomosis