Thin anastomotic causes and preventive measures

By | March 21, 2012

Repeated occurrence of anastomotic main reasons for anastomotic healing is a direct impact on several factors, followed by secondary infection, anastomotic edema due to inflammation, poor healing, which lean more appeared later. A direct impact on anastomotic healing for the following reasons.
The incidence of anastomotic thin and prevention of anastomotic Department a. poor blood supply. Stomach in the process of free, generally right gastric vein and the right gastroepiploic vein difficult to damage. However, in the free operation of esophageal and gastric stretch and kneading over powerhouse, can cause tissue damage, submucosal or intramuscular hematoma formation of small blood vessels rupture, causing blood supply to poor fit of the Ministry of anastomotic healing. Gastric cardia cancer in particular to do some or most of the resection, the Ministry of gastric blood supply cut off even worse suture, it is free in the course of the esophagus and stomach, attention should be handy to operate, to protect the esophagus and gastric serous muscular layer of the integrity of the is consistent with the Ministry of blood supply to maintain a good thin to prevent an important part of anastomosis. Free in the stomach in particular should pay attention to cut off the upper pole of the spleen and stomach ligaments, especially the stomach ligaments were too short, do not expand so as not to damage the stomach clamped beam. It is the bottom of the esophagus due to stomach – gastric anastomosis, such as anastomotic where damage will affect the blood supply and may even cause perforation of gastric necrosis.
The incidence of anastomotic thin and prevention of b. esophageal anastomosis edge of a rope is not good. Esophageal anastomosis edge of a rope is not good, but also affect anastomotic healing. Teaching film often cut off after esophageal retraction, after cutting off the stomach mucosa and often has turned outward, affecting the fit neatly fit on the edge of the rope. When cutting the esophagus with a large right angle clamp bronchus clamp or clamp off the esophagus, not only can prevent esophageal stump bleeding, anastomosis surgical field clear, and prevent the retraction of esophageal mucosa and reduce the outflow of the contents of the surgical field contamination. Partial eversion of the gastric mucosa close, bleeding that much, but there is a clear benefit in the surgical field exposure, easy to suture the esophagus and stomach tight margins on the rope. The distance between each suture needle too close match will be organized by the Ministry of blood supply, depopulation of the esophagus and stomach tight rope is not easy, but also affect healing. Each suture needle from the general (stitch length) to 0.3cm, esophagus and stomach tight to the rope is appropriate margin. Suture depth (margin) should be more than 0.5cm, suitable elastic suture ligation, suture ligation of tight too shallow, postoperative edema may cut off suture anastomosis anastomotic healing and the formation of thin. A large number of clinical cases confirmed that more than 0.5cm deep from the tangential suture only beneficial in the healing of anastomosis, anastomotic stenosis does not cause.
The incidence of anastomotic thin and prevention of anastomotic tension is too large c. also affect anastomotic healing. Internally used by the majority of patients who end side of the esophagus and stomach, "Scarf Type" embedded legal and responsible tone of the door match the stomach cancer of the esophagus after partial resection of the stomach of a set of end-esophageal gastric anastomosis, anastomotic embedded human stomach in 4cm. Folded part of the stomach longer, not oppression and stomach consistent with the Department of the outer esophageal muscular layer embedded suture, far away from the anastomosis, anastomotic blood supply to the small impact. "Scarf-style" embedded esophageal anastomosis suturing muscle and stomach muscle pulp only 3-4 needles all week. Partial resection of gastric cardia, gastric esophageal anastomosis sets only need 4-5 stitches. At the same time the two anastomosis can reduce anastomotic tension, anastomotic protection is conducive to the healing anastomosis.
Anastomotic healing caused more of several reasons, patients who are surgical operations with technical proficiency to some extent. Intraoperative exposure of the surgical field clear, gentle and meticulous operation, suture tight and accurate, the incidence of anastomotic thin significantly reduced. Intraoperative contamination and postoperative chest infection operating fluid, may cause secondary infection caused anastomotic anastomotic thin. Therefore, patients with severe obstruction, esophageal surgery should be done before washing and oral antibiotics, elimination of esophageal inflammation. Intraoperative strict protection for the surgical field, reduce pollution chest after surgery to maintain patency of thoracic drainage, excluding pleural effusion, the lung expansion as soon as possible, and before and after surgery to give sufficient quantities of antibiotics, thin anastomosis are very necessary measures to prevent .

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