消化道重建技術(shù)規(guī)范(參考版)
2025-01-24 18:07本頁面
【正文】 若發(fā)現(xiàn)殘胃殘端血供丌良，顏色發(fā)暗，應(yīng)果斷切除該部分，重新設(shè)計(jì)吻合口部位。盡量選大口徑吻合器。 [1] Kim, ., . Oh, . Oh, et al., Circular stapler size and risk of anastomotic plications in gastroduodenostomy for gastric cancer [J]. World J Surg, 2023. 36(8):17969. 吻合口狹窄 [1] Yu, S., K. Jastrow, B. Clapp, et al., Foreign material erosion after laparoscopic RouxenY gastric bypass: findings and treatment [J]. Surg Endosc, 2023. 21(7):121620. [2] Sacks, ., . Mattar, . Qureshi, et al., Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic RouxenY gastric bypass [J]. Surg Obes Relat Dis, 2023. 2(1):116. [3] Ruiz de Adana, ., A. Hernandez Matias, M. Hernandez Bartolome, et al., Risk of gastrojejunal anastomotic stricture with multifilament and monofilament sutures after handsewn laparoscopic gastric bypass: a prospective cohort study [J]. Obes Surg, 2023. 19(9):12747. [4] Vasquez, ., D. Wayne Overby, and . Farrell, Fewer gastrojejunostomy strictures and marginal ulcers with absorbable suture [J]. Surg Endosc, 2023. 23(9):20235. 術(shù)后 縫合材料 吻合前 鼓勵(lì)患者盡早開始進(jìn)食，利用食物體積，擴(kuò)張吻合口 選擇可吸收縫線，減少術(shù)后吻合口炎癥發(fā)生率 [13]。 – 翻 入過多、過度縫合、扭曲、血運(yùn)障礙、血腫、感染、器械吻合時(shí)追加 縫合。 ?若發(fā)現(xiàn)吻合環(huán)不完整，或懷疑吻合口漏時(shí)，應(yīng)用腸鉗夾閉吻合口遠(yuǎn)端胃腔后，經(jīng)胃管注入美蘭，檢查吻合口有無藍(lán)色滲出。 [1] Rahbari, ., J. Weitz, W. Hohenberger, et al., Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer [J]. Surgery, 2023. 147(3):33951. [2] Deguchi, Y., T. Fukagawa, S. Morita, et al., Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery [J]. World J Surg, 2023. 36(7):161722. [3] Markar, ., M. Penna, V. VenkatRamen, et al., Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity [J]. Surg Obes Relat Dis, 2023. 8(2):2305. 吻合口瘺 吻合器應(yīng)用和外科醫(yī)生的手術(shù)經(jīng)驗(yàn)可減少幵發(fā)癥的發(fā)生 [3]。 吻合口出血的處理 先經(jīng)胃管注入去甲腎上腺素和冰鹽水 血紅蛋白下降過快，輸血 內(nèi)鏡檢查出血點(diǎn)，可內(nèi)鏡下止血夾夾閉 治療無效 二次手術(shù) 吻合口瘺 是 吻合口處組織壁缺損從而在胃腸腔內(nèi)外產(chǎn)生的異常通道 [1]。
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號-1