Start with an emergency physician

Preservation means esophagojejunostomy, and non-preservation means triple jejunal pouch gastric replacement.

No matter which one, there is no advantage or disadvantage, you can only choose the more suitable one.

Zhou Yuan said without much hesitation:"Close the stump and perform triple jejunal pouch gastric replacement."

"Why?"

"Esophagojejunostomy requires a lot of suturing, including interrupted mattress sutures and so on. Moreover, once the mesenteric space is not completely closed, internal hernia is very likely to occur. No matter which point it is, it is not good for the patient. In comparison, the triple jejunal pouch gastric replacement is more suitable for patients."

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

Moreover, it is necessary to be very careful when closing. Once leakage occurs, only duodenostomy can be performed, or to put it simply, direct resection.

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

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

Zhou Yuan lifted up the left lobe of the liver with his right hand and cut the left triangular 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 function of the S-shaped retractor was 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 fixing it, Zhou Yuan separated the hepatogastric ligament along the lower edge of the liver and cut it off. After that, he began to clean the periarterial lymph nodes in the abdominal cavity.

""Surgical scissors."

Zhou Yuan cut open the upper peritoneum and freed the lower end of the esophagus.

"S-shaped retractor"

"Brother Haiyang, please pull the esophagus to the left and expose the esophageal hiatus.

"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 that in the chest cavity, the pressure difference will"suck" a small part of the stomach into the chest cavity, forming an esophageal hiatal hernia.

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

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

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

"Those who write novels are all miserable." Zhou Yuan said.

Suturing is Zhou Yuan's specialty. Soon, the suture was completed and Zhou Yuan fixed the esophagus to the diaphragmatic hiatus.

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

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

Because the lower part of the esophagus has no serosa, but only muscle layer, it is extremely easy to tear when suturing.

This is also one of the difficulties of total gastrectomy.

"Line 1." Zhou Yuan said.

The lower part of the esophagus is suitable for suturing with line 1.

After continuous lock-edge suturing, fix the esophageal muscle layer and mucosa, cut the esophagus 0.5 cm away from the distal end of the suture, and completely separate the stomach tube and esophagus.

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

This is considered a big step. There is one last step: remove the whole stomach!

Zhou Yuan calmed down for a while, took a deep breath, and concentrated 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 scratched, cancer cells are likely to enter the whole body with the blood flow, directly leading to the death of the patient.

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

He carefully turned the lower end of the stomach upwards to check the connection between the back wall and the pancreas.

"It can be separated." Zhou Yuan said.

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

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

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

Zhou Yuan smiled, carefully held the stomach, cleared the adhesions of the stomach tissue, and placed it on the sterile table next to him.

""Remove the tail of the pancreas, and clear the lymph nodes and blood vessels." Zhou Yuan said.

The tail of the pancreas must be removed because of tumor implantation.

The lymph nodes and blood vessels need to be cleared because gastric cancer often occurs on the lesser curvature. In order to cure it, all blood vessels, lymph and fat tissues except the hepatic blood vessels and common bile duct must be cleared. Once there is any residue, it may cause serious postoperative complications.

This is a delicate job, and it cannot be rushed. It needs to be done slowly.

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

There is no danger period and no extra attention for total gastrectomy.

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

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