教案中文版06surgery of the stomach译

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幽门腺分泌粘液和胃Gastricvasculariza=on胃的血管:==Op+malzoneforAortaCeliacA.Le=undrightGastricA.(lesser主动脉腹主动 胃左/右动脉（胃小弯Gastroduodenal

Le=andrightgastroepiploicA.(greater胃网膜左/右动脉（胃大弯Gastricvasculariza=on胃的血管AllgastricreachthePortalV.throughDuodenalV.sideofthestomach)andthev.(leR指肠静脉（胃的右侧）和脾静（胃的左侧）回流至门静Useofmoistenedlaparotomy cementofstayIntraperitonealUseofmoistenedlaparotomyThestomachiss=llnotopenandisbroughttotheskinIsola=onofthegastricareathatwillbeincisedmoistenedlaparotomyMoistenedlaparotomyActasabsorbentbarrierstocontaminaLonbygastricPreventvisceral Spongesare cedastheyare巾/Staycedintothestomachwallbefore Substan=albite(approx.1cm)topreventaccidentalIntraperitonealirriga-Dilutesoreliminatesunaccounted稀释或消除潜在污应使用温热的溶液（37°C-WarmersoluLon:vasodilaLon,hypotensionandadhesionformaLon温度较高的溶液：血管扩张、低血压和形成粘连的风CoolersoluLon:温度较低的溶液：低体Whilethefluidisintheabdomen,theorgansaregentlymanipulatedtoreposi+on Allfluidissuc+oned(blood,exsudate)becauseremainingfluidsreducesimmuneclearanceofmicroorganismsandSepLc/AsepLcLmeofagastro-‐intesLnal胃肠道手术中污染操作与无菌操作转换时Beforeclosingtheabdomen,takenewglovesandsuturingPrepara=onoftheCheckespeciallyfordehydra+on,Electrolytes,acid-‐basecardiovascularIfperitoni=sispresent,an=cipateforendotoxicshockandthirdspacefluidlosses.Prepara=onofthepa=entMostlyelec=vesurgery=emptyGastriclavageisnotmendedWaitifpossible尽可能术前给予胃酸阻断Bigchoiceofmedica=onsavailable:cime=dine,famo=dine,Proper+es:reduceacidproduc=onandpreventesophagusrefluxRani=dineisalsoprokine=c(s=mulatesgastricAnesthe=cAtropine,acepromazineandxylazinereduceloweresophagealsphinctertone.阿托品、乙酰丙嗪和塞拉可降低食道下段括约肌张Manipula+onofthedogduringInducLonandmaintenancecanleadtosilentregurgita+on.在诱导期和维持期给药可导致不自主反Quickanesthe=cInduc=onand快速诱导和维Propofol丙泊酚6mg/kg,:10mg/kg(IM,ThosemoleculeshaveThosemoleculeshaveliTleinfluenceofthegastro-‐intes+nalmo+lityExtuba=onThecuffremainsinflatedunLlswallowingandreflexThecuffisparLallydeflatedforApproaches:ventralmidlineFromthexiphoidprocessofthetothemidwaybetweenumbilicusandParacostalapproachtothestomach胃部手术的肋骨旁通Selectedcases:temporarygastrotomy(orfeedingtube).Suture缝Con+nuous连续Shorterdura=onLess nted trial(sutre两层FirstlayerincorporatealllayersoftheSecondlayerprovideinversion(Cushing,LembertorSuturetypes缝线类Stomach=abundantbloodsupplyandrapidhealing.胃 Absorbablesutureisadequate(Vicryl,Dexon,Maxon,MonocrylWhenpoorhealing(hypoproteinemia,plete siaseveredelayed-‐absorbableornonabsorbablesutureisBlood–Supportthevascularvolumewithcolloids使用胶体液维持血–Localvasculartoneisphysiologicallymodulatedbycatecholamines:儿茶酚胺可生理性调节局部血管紧–Paincontrol,bloodpressureandstress疼痛管理、维持血压、减少应PainUseofOpiodsshouldbecarefullycontrolledbecausereducesthegastroinstes=nal Importanceof gesia(Nsaidsalwayswith gesiacananop=ontoreducepainandimprovemo=lity.Nutri=ons+mulatesthemo+lityandgastrointes+nalhealing(useofprokine=cagentasadjuvant).FeedthedogsoonaspossibleSmallquan+tywithMorefrequentGastrotomy胃切开IndicaLons:biopsies,foreign适应症：活检、异Incats:trichobezoarsandstringorForeignbodiesinYoungeranimalsareAmazingdiversityofforeignTheanimalispresented yaeerconsumingaforeignBoTlecap瓶Inducevomi+ngisnotawisetreatmentop+oninthisGastrotomy胃切开Betweenthegreaterandlessercurvaturewherethebloodsupplyisnotabundant胃大弯和胃小弯之间血管较少的区域Catchtheforeignbodythe 使用合适的器械钳夹异Thestaysuturesmaintainthewoundedgeelevatedtoavoidstomachcontentspillage.ExtracLonoftheforeignbodyissomeLmesdifficultSutureoftheLighteversionoftheSutureoftheSmallgastrectomyIndica+ons:适应LocalizedtumorGastriculceraLon–PerforaLonorruptureGastricwallaRerGDVGastricforGDVinducedTheinvaginaLonisbegunby acon+nuousinver+ngsuture(CushingpaGern)with‐0PDSgrabbinghealthyLssueatthedoTedlines.胃内陷术：先沿虚线使用0连续内翻缝合健康组2ndinver=ngcon=nuousTheinvagina=oniscompletedwithasecondlayerofinver=ngsuture(Lembert再进行第二层内翻缝合（伦伯特缝合）ParLalgastrectomywithalocalizedparietal对局部胃壁肿物进行胃部分切除A=ergastrectomywhichneedstodealwiththebloodclosureofthewoundedgesisiden+caltoa胃切除术时应考 ，切除后缝合与胃切开相Gastropexy胃固定Goalsofthegastropexy:胃固定术的目Permanentadhesionbetweenthepyloricantrumandtherightla lbodywall.NointerferencewithnormalstomachposiLonandfuncLon.不影响胃的正常位置和功能Thepexyshouldnotservedasapivotpossibilityforsomeorgans(intesLnes,spleen)固定术后不应造成 Incisionalgastropexy56cmlongincisioninthepyloricantrumTheunderlyingmucosaisidenLfiablewithreddishabout‐8cmlat.totheElectrocauteryiso=ennecessary常需要电凝止Thefirstcon=nuouspa`ernisThe1stcon=nuouspa`ernisThe2ndcon=nuouspa`ernisEleva+onofthegastricpatch(Antrumpylori)Visualiza=onofthe2parallel‐cmincisionsaremade3cmappart,perpendiculartothelongaxisofthestomachincisions(2cmIncisionsthroughthe andthetransverseabdominalPassagethroughthetunnelFinalaspectaeerSamesuturesusedasforthein