Start as an Emergency Physician

Retention means esophageal-jejunostomy, and non-retention means triple-jejunal sac gastric substitution.

Either way, there is no way to say what the advantages and disadvantages are, you can only choose the more suitable one.

Zhou Yuan didn't hesitate too much, and said, "Close the severed end and perform a three-fold jejunal sac gastric replacement." "

"Why?".

"Esophageal-jejunostomy requires a lot of sutures, including intermittent mattress sutures and so on. Moreover, once the mesangial space is not completely closed, internal herniation is very likely to occur. Either way, it is detrimental to the patient, and in contrast, triple-stack jejunal sac gastric replacement is more suitable for the patient. "

After speaking, Zhou Yuan closed the severed end of the duodenum. It is also important to note here that the free stump of the duodenum should not be larger than one centimeter, otherwise blood circulation will be affected.

Moreover, it is necessary to be very careful when closing, and once there is leakage, only duodenostomy can be performed, which is to put it in layman's terms, and it is directly removed.

After doing this step, Zhou Yuan began to reveal the fundus and esophagus.

Everyone quieted down again, not daring to disturb Zhou Yuan.

I saw Zhou Yuan holding up the left lobe of the liver with his right hand and cutting the left deltoid ligament. On the other side, He Jianyi immediately cut off the ligament with blood vessels and ligated it.

S-shaped retractor. Zhou Yuan stretched out his hand.

The effect of the S-shaped retractor is similar to the previous one, after Jiang Xiaoqi let go, Zhou Yuan used the retractor to pull the left lobe of the liver to the right, and at the same time, pulled the stomach to the left.

After fixation, Zhou Yuan separated the hepatogastric ligament along the lower edge of the liver, severed it, and began to dissect the periarterial lymph nodes in the abdominal cavity after completion.

"Surgical scissors. "

As he spoke, Zhou Yuan cut open the upper peritoneum, leaving the lower end of the esophagus free.

S-shaped retractor. "

"Senior Brother Haiyang, you can pull the esophagus open to the left side and expose the esophageal hiatus. "

The ocean hurried up.

"The hiatus of the esophagus is too big... Line 4. Zhou Yuan said.

Normally, the hiatus of the esophagus is just enough for the esophagus to pass through. When the hiatus is too large, because the pressure in the abdominal cavity is greater than in the chest cavity, the pressure difference can "inhale" a small part of the stomach into the chest cavity, forming a hiatal hernia.

Once a hiatal hernia occurs, the organs that enter the chest cavity will affect the heart and lungs, affect circulation, breathing and other functions, and even cause complications such as massive bleeding and reflux esophageal stricture.

Therefore, if the esophageal hiatus is found to be too large during surgery, it must be sutured.

"Yang Wei is quite miserable..."The ocean shook his head.

"Anyone who writes novels is miserable. Zhou Yuandao.

Suturing is Zhou Yuan's specialty, and soon, after the suturing is completed, Zhou Yuan fixed the esophagus in the diaphragm hiatus.

"The next step is to cut off the cardia. It's also the last step before resection. Zhou Yuan reminded.

As long as the cardia is cut, almost the entire stomach has been completely separated from the body, and then only some adhesions need to be dealt with to complete the total gastrectomy.

Because the lower part of the esophagus does not have a serous membrane, it is all muscle, and it is extremely easy to tear when sutured.

This is also one of the difficulties of total gastrectomy.

"Line 1. Zhou Yuandao.

The lower esophagus is suitable for suture with a 1-gauge thread.

Successive seam sutures are followed by fixation of the esophageal muscular layer and mucosa, and the esophagus is severed 0.5 cm from the distal end of the suture, completely separating the gastric tube from the esophagus.

When the fresh stomach tube came out of the esophagus alive, everyone present breathed a sigh of relief.

This is a big step, and then there's the final step: the removal of the whole stomach!

Zhou Yuan calmed down for a while, took a deep breath, and became engrossed again.

This step is not complicated, but it is very risky.

At this time, many blood vessels around the stomach have been exposed, and if the tumor accidentally cuts the stomach body, the cancer cells are likely to enter the body with the bloodstream, directly leading to the death of the patient.

Zhou Yuan naturally would not make such a low-level mistake.

He cautiously flipped the lower end of his stomach up to see the connection between the posterior wall and the pancreas.

"It can be separated. Zhou Yuan said.

He Jian nodded, manipulating the scalpel to separate the fibrous tissue between the posterior wall of the stomach and the pancreas little by little.

After the separation, Zhou Yuan again separated and ligated the gastrosplenic ligament and the short gastric blood vessels connecting the spleen and cut off the distal end.

After this severance, the body of the stomach is completely separated from the human body.

Zhou Yuan had a smile on his face, carefully held his stomach, cleared the adhesions of stomach tissues, and placed it on the sterile table next to him.

"The tail of the pancreatic body is removed, and the lymph nodes and blood vessels are cleaned. Zhou Yuandao.

The tail of the pancreatic body had to be removed because of the tumor implantation.

In order to cure the radical curvature, it is necessary to dissect all blood vessels, lymph and adipose tissues except for hepatic blood vessels and common bile ducts, and once there is a residue, it may cause serious postoperative complications.

This is delicate work, which cannot be rushed, and requires slow work.

He Jianyi and Jiang Xiaoqi, including the beautiful little nurse, all looked at Zhou Yuan intently.

With a total gastrectomy, there is no danger period and nothing to pay attention to.

Because, any process can be fatal, and any mistake may lead to the spread of cancer cells in the blood, bringing irreversible consequences!

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The ninth will be delivered, and the tenth will be delivered a little later!

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