教案中文版06surgery of the stomach譯

Anatomyofthestomachin犬胃部Stomach=largestdila+onoftheAlimentaryc InterposedbetweentheEsophagusandthepilorus.Shapedsomewhat

theleGerCrotated90inaCounterclockwiseVariablestomachposi=onintheEmpty,thestomachlaysunderthecostalFull,thestomachbloatescaudallypushingalltheabdominalVentralaspectofthestomachattheVentralleafoftheomentum…andglandular…ProperPropergastricglandregionPyloricPyloricglandAcideandenzymessecre=onbythepropergastric胃固有腺分泌胃酸Mucusandgastrinsecre=onbythepyloric幽門腺分泌粘液和胃Gastricvasculariza=on胃的血管:==Op+malzoneforAortaCeliacA.Le=undrightGastricA.(lesser主動脈腹主動 胃左/右動脈（胃小彎Gastroduodenal

Le=andrightgastroepiploicA.(greater胃網(wǎng)膜左/右動脈（胃大彎Gastricvasculariza=on胃的血管AllgastricreachthePortalV.throughDuodenalV.sideofthestomach)andthev.(leR指腸靜脈（胃的右側(cè)）和脾靜（胃的左側(cè)）回流至門靜Useofmoistenedlaparotomy cementofstayIntraperitonealUseofmoistenedlaparotomyThestomachiss=llnotopenandisbroughttotheskinIsola=onofthegastricareathatwillbeincisedmoistenedlaparotomyMoistenedlaparotomyActasabsorbentbarrierstocontaminaLonbygastricPreventvisceral Spongesare cedastheyare巾/Staycedintothestomachwallbefore Substan=albite(approx.1cm)topreventaccidentalIntraperitonealirriga-Dilutesoreliminatesunaccounted稀釋或消除潛在污應(yīng)使用溫?zé)岬娜芤海?7°C-WarmersoluLon:vasodilaLon,hypotensionandadhesionformaLon溫度較高的溶液：血管擴張、低血壓和形成粘連的風(fēng)CoolersoluLon:溫度較低的溶液：低體Whilethe?uidisintheabdomen,theorgansaregentlymanipulatedtoreposi+on All?uidissuc+oned(blood,exsudate)becauseremaining?uidsreducesimmuneclearanceofmicroorganismsandSepLc/AsepLcLmeofagastro-‐intesLnal胃腸道手術(shù)中污染操作與無菌操作轉(zhuǎn)換時Beforeclosingtheabdomen,takenewglovesandsuturingPrepara=onoftheCheckespeciallyfordehydra+on,Electrolytes,acid-‐basecardiovascularIfperitoni=sispresent,an=cipateforendotoxicshockandthirdspace?uidlosses.Prepara=onofthepa=entMostlyelec=vesurgery=emptyGastriclavageisnotmendedWaitifpossible盡可能術(shù)前給予胃酸阻斷Bigchoiceofmedica=onsavailable:cime=dine,famo=dine,Proper+es:reduceacidproduc=onandpreventesophagusre?uxRani=dineisalsoprokine=c(s=mulatesgastricAnesthe=cAtropine,acepromazineandxylazinereduceloweresophagealsphinctertone.阿托品、乙酰丙嗪和塞拉可降低食道下段括約肌張Manipula+onofthedogduringInducLonandmaintenancecanleadtosilentregurgita+on.在誘導(dǎo)期和維持期給藥可導(dǎo)致不自主反Quickanesthe=cInduc=onand快速誘導(dǎo)和維Propofol丙泊酚6mg/kg,:10mg/kg(IM,ThosemoleculeshaveThosemoleculeshaveliTlein?uenceofthegastro-‐intes+nalmo+lityExtuba=onThecu?remainsin?atedunLlswallowingandre?exThecu?isparLallyde?atedforApproaches:ventralmidlineFromthexiphoidprocessofthetothemidwaybetweenumbilicusandParacostalapproachtothestomach胃部手術(shù)的肋骨旁通Selectedcases:temporarygastrotomy(orfeedingtube).Suture縫Con+nuous連續(xù)Shorterdura=onLess nted trial(sutre兩層FirstlayerincorporatealllayersoftheSecondlayerprovideinversion(Cushing,LembertorSuturetypes縫線類Stomach=abundantbloodsupplyandrapidhealing.胃 Absorbablesutureisadequate(Vicryl,Dexon,Maxon,MonocrylWhenpoorhealing(hypoproteinemia,plete siaseveredelayed-‐absorbableornonabsorbablesutureisBlood–Supportthevascularvolumewithcolloids使用膠體液維持血–Localvasculartoneisphysiologicallymodulatedbycatecholamines:兒茶酚胺可生理性調(diào)節(jié)局部血管緊–Paincontrol,bloodpressureandstress疼痛管理、維持血壓、減少應(yīng)PainUseofOpiodsshouldbecarefullycontrolledbecausereducesthegastroinstes=nal Importanceof gesia(Nsaidsalwayswith gesiacananop=ontoreducepainandimprovemo=lity.Nutri=ons+mulatesthemo+lityandgastrointes+nalhealing(useofprokine=cagentasadjuvant).FeedthedogsoonaspossibleSmallquan+tywithMorefrequentGastrotomy胃切開IndicaLons:biopsies,foreign適應(yīng)癥：活檢、異Incats:trichobezoarsandstringorForeignbodiesinYoungeranimalsareAmazingdiversityofforeignTheanimalispresented yaeerconsumingaforeignBoTlecap瓶Inducevomi+ngisnotawisetreatmentop+oninthisGastrotomy胃切開Betweenthegreaterandlessercurvaturewherethebloodsupplyisnotabundant胃大彎和胃小彎之間血管較少的區(qū)域Catchtheforeignbodythe 使用合適的器械鉗夾異Thestaysuturesmaintainthewoundedgeelevatedtoavoidstomachcontentspillage.ExtracLonoftheforeignbodyissomeLmesdi?cultSutureoftheLighteversionoftheSutureoftheSmallgastrectomyIndica+ons:適應(yīng)LocalizedtumorGastriculceraLon–PerforaLonorruptureGastricwallaRerGDVGastricforGDVinducedTheinvaginaLonisbegunby acon+nuousinver+ngsuture(CushingpaGern)with‐0PDSgrabbinghealthyLssueatthedoTedlines.胃內(nèi)陷術(shù)：先沿虛線使用0連續(xù)內(nèi)翻縫合健康組2ndinver=ngcon=nuousTheinvagina=oniscompletedwithasecondlayerofinver=ngsuture(Lembert再進(jìn)行第二層內(nèi)翻縫合（倫伯特縫合）ParLalgastrectomywithalocalizedparietal對局部胃壁腫物進(jìn)行胃部分切除A=ergastrectomywhichneedstodealwiththebloodclosureofthewoundedgesisiden+caltoa胃切除術(shù)時應(yīng)考 ，切除后縫合與胃切開相Gastropexy胃固定Goalsofthegastropexy:胃固定術(shù)的目Permanentadhesionbetweenthepyloricantrumandtherightla lbodywall.NointerferencewithnormalstomachposiLonandfuncLon.不影響胃的正常位置和功能Thepexyshouldnotservedasapivotpossibilityforsomeorgans(intesLnes,spleen)固定術(shù)后不應(yīng)造成 Incisionalgastropexy56cmlongincisioninthepyloricantrumTheunderlyingmucosaisidenL?ablewithreddishabout‐8cmlat.totheElectrocauteryiso=ennecessary常需要電凝止The?rstcon=nuouspa`ernisThe1stcon=nuouspa`ernisThe2ndcon=nuouspa`ernisEleva+onofthegastricpatch(Antrumpylori)Visualiza=onofthe2parallel‐cmincisionsaremade3cmappart,perpendiculartothelongaxisofthestomachincisions(2cmIncisionsthroughthe andthetransverseabdominalPassagethroughthetunnelFinalaspectaeerSamesuturesusedasforthein