Start with the emergency physician

Retention means esophageal jejunostomy, and no retention means triassic gastric surrogate.

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

Zhou Yuan didn’t hesitate too much and said, “Seal the severed end and perform triassic 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 hernia is highly prone to occur. Either way, it is detrimental to the patient, in contrast, tristacked jejunal cyst gastric surrogacy is more suitable for the patient. ”

After speaking, Zhou Yuan closed the severed end of the duodenum. Special attention should also be paid here that the free stump of the duodenum should not be larger than one centimeter, otherwise blood supply will be affected.

Moreover, it is necessary to be very careful when closing, and once there is leakage, only duodenostomy can be performed, to put it more generally, it is directly removed.

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

Everyone was quiet again, not daring to disturb Zhou Yuan.

I saw that Zhou Yuan’s right hand held up the left lobe of the liver and cut the left delta ligament. On the other side, He Jianyi immediately cut off the ligaments with blood vessels and ligated them.

“S-shaped pull hook.” Zhou Yuan stretched out his hand.

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

After fixation, Zhou Yuan separated the ligaments of the liver and stomach along the lower edge of the liver, cut them off, and began to clean the periarterial lymph nodes in the abdominal cavity after completion.

“Surgical scissors.”

Saying that, Zhou Yuan cut the upper peritoneum, so that the lower end of the esophagus came out.

“S-shaped pull hook.”

“Senior Brother Haiyang, you can pull the esophagus to the left and reveal the esophageal tear.”

The ocean quickly ran up.

“The esophageal hiatus is too big… Line 4. Zhou Yuan said.

Normally, the esophageal hiatus is just enough to allow the esophagus to pass through. When the hiatal hiatus is too large, because the pressure in the abdominal cavity is greater than in the chest cavity, the pressure difference “inhales” a small part of the stomach into the chest cavity, forming a hiatal hernia.

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

Therefore, if a large hiatal is found to be large during surgery, sutures must be performed.

“Yang Wei is quite miserable…” Ocean shook his head.

“People who write novels are miserable.” Zhou Yuandao.

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

“The next step is to cut the gate. It is also the last step before excision. Zhou Yuan reminded.

As long as the cardia is cut off, almost the entire stomach has been completely separated from the body, and then only some adhesion tissue needs to be processed to complete the total gastrectomy.

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

This is also one of the difficulties of total gastrectomy.

“Line One.” Zhou Yuandao.

The lower esophagus is suitable for suture with thread 1.

The esophageal muscular layer and mucosa are fixed after successive seam closures, and the esophagus is cut off 0.5 cm from the distal end of the suture, completely separating the gastric tube from the esophagus.

When the fresh gastric tube bounced out of the esophagus, everyone present breathed a sigh of relief.

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

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

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

At this time, many blood vessels around the stomach have been exposed, and once the tumor of the stomach body is accidentally cut, the cancer cells are likely to enter the whole 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 flips the lower end of his stomach upwards to see the connection between the posterior wall and the pancreas.

“Can be separated.” Zhou Yuan said.

He Jian nodded, manipulated the scalpel, and separated the fibrous tissue between the back wall of the stomach and the pancreas little by little.

After the separation, Zhou Yuan again separated and ligated the gastric and splenic ligaments connected to the spleen and the short gastric blood vessels and cut the distal end.

After this cut-off, the stomach body is completely separated from the human body.

With a smile on his face, Zhou Yuan carefully held his stomach, removed the adhesions of the stomach tissue, and placed it on the sterile table next to him.

“Excise the tail of the pancreatic body, remove lymph nodes and blood vessels.” Zhou Yuandao.

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

The removal of lymph nodes and blood vessels is because gastric cancer mostly occurs on the small curved side, in order to cure it, all blood vessels, lymph and fat tissue except liver blood vessels and common bile duct must be cleaned, once there is a residue, it may cause serious postoperative complications.

This is delicate work, urgent, and requires slow work.

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

With total gastrectomy, there is no dangerous period and nothing that requires additional attention.

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

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The ninth is delivered, and the tenth is delivered later!

Brothers, I have worked hard, what are you waiting for, help me reach the top of the Feilu monthly ticket list!