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ID:49341335
大小:1.99 MB
页数:16页
时间:2020-02-03
《食管癌颈部吻合.ppt》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、cervicalesophagogastricanastomosisendoscopiclinearcuttingstaplercircularstaplerendoscopiclinearcuttingstaplerendoscopiclinearcuttingstaplerTheanteriorwallisconstructedwitharunningsuturePartialmechanicalcervicalesophagogastricanastomotictechniqueproceduresone:posteri
2、or-posteriorposterolateralaspectoftheesophagogastricanastomosisPartialmechanicalcervicalesophagogastricanastomotictechniqueprocedurestwo:posterior-anteriorPartialmechanicalcervicalesophagogastricanastomotictechniqueproceduresthree:modifiedposterior-anteriorprocedure
3、sthree:modifiedposterior-anteriorA,ThetwoanastomoticstaysuturesareretracteddownwardastheEndo-GIA30-3.5staplecartridgeisinserted,thethinneranvilportionintothestomachandthethickerstaple-bearingportionintotheesophagus.B,Asthestaplecartridgeisadvancedcompletelyintothees
4、ophagusandstomach,itisgraduallyrotatedsothatthetipispointingtowardthepatient’srightear.A,Thehandleofthestaplerissqueezed,therebyapproximatingthejaws,butbeforefiringit,thestaplerisrolledfromonesidetotheotherastwosuspensionseromuscularsuturesbetweentheadjacentesophagu
5、sandstomachareplacedoneitherside.B,Thestaplerisfiredbyadvancingtheknifeassembly,anda3-cmlongside-to-sideanastomosisiscreatedasthecommonwallsbetweentheesophagusandstomacharecut.Afterremovingthestapler,theanastomosisisinspectedforbleeding,andanasogastrictubeisinserted
6、.Cornersuturesareplacedinpreparationforcompletionoftheanastomosis.Thegastrotomyandremainingopenesophagusareclosedin2layers:arunninginnerlayerof4-0monofilamentabsorbablesuture(A)andanouterinterruptedlayerthatincorporatestheanteriorwalloftheupperesophagus(B).Thisfinal
7、anteriorclosureofthegastrotomyandesophagotomyisindependentoftheactualside-to-sideanastomosis,whichiscontainedwithinthehoodoftheoverlyingesophagusTotalmechanicalcervicalesophagogastricanastomotictechniqueposterolateralaspectoftheesophagogastricanastomosiscircularstap
8、lerAcircularstaplingdevicewasintroducedthroughthegastrotomyatthetopofthegastrictubeandpassedthroughtheposteriorwallofthegastrictube.Theanv
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