Start From Emergency Doctor

Chapter 57

Retention means performing an esophageal jejunostomy, and non-reserving means performing a three-fold jejunal cyst for stomach replacement.

No matter which one is, there is no way to say that there are any advantages and disadvantages, and 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 cyst to replace the stomach.”

“why?”

“Esophageal jejunal anastomosis requires a lot of sutures, including intermittent mattress sutures, etc. Moreover, once the mesangial space is not completely closed, internal hernias are very likely to occur. No matter what it is, it is not good for the patient. In comparison, , The triple-fold jejunal cyst replacement stomach surgery is more suitable for patients.”

After speaking, Zhou Yuan stumped the duodenum and closed it. It is also necessary to pay special attention here, the free stump of the duodenum cannot be greater than one centimeter, otherwise the blood supply will be affected.

Moreover, you must be very careful when closing. Once leakage occurs, you can only perform duodenal fistula, which is a bit more popular, and remove it directly.

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

Everyone was quiet again, and did not dare to disturb Zhou Yuan.

Zhou Yuan held up the left lobe of the liver with his right hand and cut the left deltoid ligament. On the other side, He Jianyi immediately cut off the vascularized ligament and ligated it.

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

The function of the s-shaped retractor is similar to the previous one. After Jiang Xiaoqi let go, Zhou Yuan used the retractor to open the left lobe of the liver to the right, and at the same time, pulled the stomach to the left.

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

“Surgery scissors.”

With that, Zhou Yuan cut open the upper peritoneum, freeing the lower end of the esophagus.

“S-shaped hook.”

“Brother Haiyang, you can pull the esophagus to the left to reveal the hiatus.”

The ocean ran up quickly.

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

Under normal circumstances, the esophageal hiatus can just accommodate the passage of the esophagus. When the esophageal hiatus is too large, because the pressure in the abdominal cavity is greater than the thoracic cavity, the pressure difference will “suck” a small part of the stomach into the chest cavity, forming a hiatal hernia.(Read more @ wuxiax.com)

Once an esophageal hiatus hernia occurs, the organs that enter the chest cavity will affect the heart and lungs, affecting circulation, breathing and other functions, and even complications such as hemorrhage and reflux esophageal stenosis will occur.

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

“Yang Wei is very miserable…” Haiyang shook his head.

“The writers are miserable.” Zhou Yuan said.

Suture is Zhou Yuan’s specialty. Soon after the suture was completed, Zhou Yuan fixed the esophagus in the diaphragm hiatus.

“Next is to cut off the cardia. It is also the last step before the resection.” 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 adhered tissues are needed to complete the total gastrectomy.

Because there is no serosal membrane in the lower part of the esophagus, it is all muscle layer, which is extremely easy to tear when sutured.

This is also one of the difficulties of total gastrectomy.

“Line 1.” Zhou Yuan said.

The lower part of the esophagus is suitable for suture with No. 1 thread.

Continuous seaming sutures, then fix the esophageal muscle layer and mucosa, cut off the esophagus at a distance of centimeters from the distal end of the suture, and completely separate the gastric tube from the esophagus.

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

This is a big step, and then there is the last step: removing the entire stomach!

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

Although this step is not complicated, it is very risky.

At this time, many blood vessels around the stomach have been exposed. Once the tumor in the stomach body is accidentally cut, cancer cells are likely to enter the body with the bloodstream and directly lead to the death of the patient.

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

He carefully turned the lower end of his stomach up and looked at the connection between the back wall and the pancreas.

“It can be separated.” Zhou Yuan said.

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

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

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

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

“Remove the body and tail of the pancreas, and clean the lymph nodes and blood vessels.” Zhou Yuan said.

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

Lymph nodes and blood vessels are cleaned because gastric cancer mostly occurs on the side of the minor curvature. In order to cure it, all blood vessels, lymphatics and fatty tissues except the hepatic blood vessels and common bile duct must be cleaned. Once there are residuals, it may cause serious postoperative surgery. complication.

This is meticulous work, not in a hurry, and requires slow work.

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

In total gastrectomy, there are no dangerous periods and no points that require additional attention.

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

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

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