食管癌颈部吻合.ppt

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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