医学精品课件：Resection of small boweland end to end anastomosis .ppt

1、Resection of small bowel and end-to-end anastomosis,TongJi hospital Department of thoracic surgery Jerry Zhang,Company Logo,Anatomy,The small bowel lies in the central and lower parts, and is divided into 3 parts: duodenum ,jejunum and ileum.,jejunum,ileum,Company Logo,Differences of jejunum and ile

2、um,Company Logo,Mesentery,Mesentery is made up of two layers of peritoneum. It contains the vessel nerve and lymph. Between the Mesentery and thebowel ,there is a area called Mesenteric triangle. There is no serosa here ,so we must be careful. Otherwise it would leed to anastomotic fistula and infec

3、tion.,Mesenteric triangle,Mesentery,Company Logo,Intestinal arteries,The intestinal arteries arise from the superior mesenteric artery.the neighbouring branches anastomose to form a series arches. So V-shaped incision is needed in this operation.,Company Logo,Surgical indications,小肠坏死 The small inte

4、stine necrosis 小肠肿瘤 small intestinal tumor 小肠广泛性创伤 Small intestine generalized trauma 小肠先天性闭锁或狭窄 The small intestine of congenital atresia or stricture 小肠某些局部病变local affection(如结核tuberculosis、溃疡穿孔ulcer perforation、局限性回肠炎regional ileitis) 小肠移植 small intestine transplantation,Company Logo,Surgical ind

5、ications,necrosis,ulcer perforation,stricture,ileitis,Company Logo,Procedures,preparation 1.preparation of animals: anesthesia disinfectiondraping 2.Incision : right mid-abdominal rectus muscle incision or midline incision,Company Logo,Procedures,Dissection of the mesentery 1.A loop of small bowel i

6、s chosen and placed on a piece of gauze. 2.We can do it just the same way as we do in appendicectomy and splenectomy ,the vessels of the loop are isolatedclampeddividedligated. the mesentery at the cut end must be Detached closely from the intestinal wall for about 1cm long.this is to make the two c

7、ut ends naked to favour anastomosis .,Company Logo,Procedures,Dissection of the mesentery,Company Logo,Procedures,Resection of the small bowel clamp cut clean up disinfection,Company Logo,Procedures,End-to-end anastomosis Traction stitches Simple interrupted varus suture for the full layer: the posterior layer and the anterior layer. Remove the intestinal clamps and gauze Lembert for sero-muscular layer Check the anastomotic stoma Closure of the gap of mesentery. Check :if there is no active bleeding, close the abdomen layer by layer.,Company Logo,Procedures,Thank You !,