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1、第七节 犬胃切开术 Canine gastrotomy,【indication】 Extraction of foreign body in stomach, excision of tumar or necrotic stomach wall , correction of acute dilatation of stomach-torsive, gastro decompression， biopsy of chronic gastritis and food allergy.胃内异物的取出、肿瘤的切除，急性胃扩张扭转的整复，胃肠减压切开减压或坏死胃壁的切除，慢性胃炎或食物过敏时胃壁活组织
2、检查等。,Ventrodorsal腹背 survey测量 radiograph of the abdomen of a dog with ingested pennies.,Lateral survey radiograph showing stacked堆起pennies in the stomach.,Abdominal radiographs confirmed the presence of an air filled spherical（球形的） structure in the area of the stomach,Arrows point to the distended ab
3、domen. This dog is normally very thin.,This view is of the dog laying on its side under anesthesia. The ballooning of the abdomen is apparent.,This is the x-ray image of the dog prior to the procedure to relieve the gas distension,【preoperative preparation】非紧急手术，禁食24h以上。急性胃扩张扭转病犬，术前积极补充血容量和调整酸碱平衡。出现
4、休克症状的犬应纠正，快速静脉内输液应有中心静脉压监护，静注林格尔氏液与5葡萄糖或糖盐水，剂量为80l00ml/kgbw，静注氢化考地松和氟美松各410mg/kgbw，氯霉素50mg/kgbw。在静脉快速补液的同时，经口插入胃管以导出胃内蓄积的气体、液体或食物，以减轻胃内压力。,【anesthesia】全身麻醉，气管内插入气管导管，以保证呼吸道通畅，减少呼吸道死腔和防止胃内容物逆流误咽。 【restrain】仰卧保定。 【operative approach】脐前腹中线切口。 【operative method 1】,Incise abdominal wall on medioventral l
5、ine ahead navel and abdominal cavity 脐前腹中线切开腹壁，暴露腹腔,Incise peritoneum 切开腹膜,Pull the falciform ligament out of the incision将镰状韧带拉出切口外,Ligate and excise the falciform ligament 结扎后切除镰状韧带,Put sterilized gauge at the sides of wound and apply retractor to the incision. 切口两边衬以纱布后装置牵开器,Pull stomach out of t
6、he wound 将胃牵引至创口外,Select incising position between greater and lesser curvature of the stomach with less of blood vessel 在胃大弯和胃小弯之间血管较少处确定切口,Suture 2 traction lines at the two ends of schedualed incision on stomach 在预定切口线两侧装置固定牵引线,Incise stomach wall切开胃壁,Connect the whole stomach wall by continuous
7、suture or Connel suture全层连续缝合或康乃尔缝合,Connect serosa and muscle layer by inverting suture 内翻缝合胃壁浆膜肌层,Close abdominal incision常规闭合腹壁切口,【术后治疗与护理】 1.术后24h内禁饲，不限饮水。 2.24h后给予少量肉汤或牛奶，术后3天可给予软的易 消化的食物，应少量多次喂给。 3.在恢复期间，注意动物水、电解质及酸碱平衡是否 发生了失调，必要时应予以纠正。 4.术后5天内每天定时给予抗生素，可首先选用氯霉素 150mgkg体重，每天二次肌肉注射。 5.密切观察胃的解剖复位
8、情况，特别在胃扩张扭转 的病犬，经胃切开减压整复后，注意犬的症状变 化，一旦发现胃扩张扭转复发，应立即进行救治,6. a percutaneous经皮的 gastrotomy tube (stomach tube) enabling their owner to force feed kitty小猫 to re-establish consistent nutrition.,Laparoscopy腹腔镜检查 was performed with umbilical脐带的 telescope portal入口 and a right paracostal operative portal. Th
9、e pyloric幽门 antrum窦 was grasped and elevated to the right paracostal operative portal,腹腔镜手术,【术式 2】,The telescope and a pair of Vulsellum forceps were placed into the stomach through the gastrotomy incision. The ping pong ball was visualized显现, grasped with the Vulsellum forceps,Gastric dilatation an
10、d volvulus 胃扩张和扭转,A dog with a bloating stomach has a short time to live without emergency veterinary intervention. Once the stomach is unable to expel gasses produced from fermentation within the stomach, a series of events occur that result ultimately in such intra abdominal pressure that the dog
11、is unable to survive. Circulatory collapse and heart failure ultimately result, after extreme stretching of the stomach wall, constriction of intra abdominal blood vessels, widespread death and destruction of the stomach wall, and release of intestinal toxins.,The x-ray demonstrates the extreme dist
12、ension of the stomach that occurs with bloat.,X-rays are helpful to establish the presence of abnormalities other than the obvious distended stomach. Plus some evidence of Volvulus (twisting) can be seen if present. This dog did not have a volvulus of the stomach.,Carefully an incision is made in th
13、e midline abdomen. The stomach wall will be pushed tightly to the inside of the abdomen due to the high pressure inside the stomach; incising the stomach at this point is not desired.,The stomach wall is located and a small stab刺 incision is made to relieve gastric pressure. unless a gastric tube ca
14、n be safely inserted through the esophagus食管 and into the stomach. In this case the stomach was not incised,The stomach wall pushes up through the incision and is carefully examined for any perforation穿孔 or tearing of the stomach. Once pressure is neutralized中性 the stomach can be evaluated for twist
15、ing or malposition错位. In this case the stomach wall looks healthy and is not extremely stretched thin. Dark bruising is not visible, the stomach wall has been oxygenated用氧饱和了的.,The patient, lying on his back, has the stomach gas and semi-liquid food removed via a stomach tube. The pulse monitor is s
16、een attached to the tongue, the endotracheal tube is just below the tongue and delivers the gas anesthetic, and the stomach tube is seen draining排泄 the brownish带褐色的 stomach contents.,The abdominal tissues are examined, especially the spleen and its vessels seen in this image. In some cases the spleen is severely congested with blood due to the twisting of the stomach on the supporting tissues. which also contain the blood vessels to and from the spleen. Occasionally the spleen needs to be removed at this time. The stomach is often sutured in place to the abdominal wall if necessary,
