Chapter 1343 【1343】It Is Not Easy for Doctors to Find the Focus

Clinically, it is simply called a gastric tube. The gastric tube is relatively short and easy to insert. The passage from the nose to the esophagus to the stomach is relatively unobstructed and can usually be inserted blindly by a nurse.

Other catheters are more complicated, and the nasoduodenal tube, nasojejunal tube, and jejunostomy tube are all inserted into the intestine. The twists and turns of the human intestines are like nine bends and eighteen bends, so blind insertion is very difficult. It is usually reserved by the surgeon during surgery, or intubated under visual conditions through a gastroenterological endoscope.

For these patients after gastrointestinal resection, it can be said that this kind of tube is kept during the operation based on the routine risk considerations of the surgeons. The possibility of anastomotic leakage in the postoperative patient should be considered, which is called just in case.

Patients with anastomotic leakage cannot eat orally normally, and what they eat will overflow through the fistula and cause infection in the body, so they must fast at the front of the fistula. There is a nutrition tube that reaches below the fistula, and can continue to give patients enteral nutrition support. For this kind of patients, it is called a life tube. In the same way, the patient now has an anastomotic fistula after the operation, and the fistula has not grown well, so the nasojejunal tube has not been removed. At the same time, there is definitely no need for jejunostomy.

We mentioned anastomotic leakage before, and now we talk about anastomotic leakage, which is closely related to surgery, yes, so the word anastomotic stoma is added in front of fistula. After all, fistula is not only caused by surgery, but also caused by the patient's own disease and trauma. For example, anal fistula, intestinal fistula, etc. that have nothing to do with surgery cannot be called anastomotic fistula.

Anastomotic stoma, as the name suggests, is the junction point where the front and rear healthy tissues and organs are reconnected after the diseased part of the organ is surgically removed. The surgical procedure is called an anastomosis, for which this junction is called an anastomotic stoma.

It is necessary to understand these terms accurately in order to understand where the anastomotic leakage usually hides. To deal with anastomotic leakage, the doctor must first find the fistula. The problem is that the fistula is not easy to find at first. It stands to reason that anastomotic leakage is related to surgery, and the chief surgeon knows best where the surgical anastomosis is, so the chief surgeon can find the fistula there. The chief surgeon can do this, but it needs to be re-operated. Laparotomy or laparoscopy are all relatively harmful methods. Patients may not be able to tolerate prolonged lying on the operating table for such surgical procedures again. This patient just happened to be in poor physical condition. The surgeon needs to think twice about the choice of operating on him again, so the first choice is not to use surgical methods to solve the fistula, so as to prevent the patient from being unable to get off the operating table.

Without surgery, the fistula can be found in the patient's digestive tract by using a digestive endoscope. Digestive endoscopy is not like surgery, which can open the intestines to find it. It can only find and block fistulas in the digestive tract with the limited field of view and limited auxiliary instruments. Therefore, a master of internal medicine may be reflected in how to play a digestive endoscope.

I have heard from Senior Sister Jiang that Senior Brother Yu is an expert in digestive endoscopy. Xie Wanying and two classmates continued to observe and study the conversation between Senior Brother Yu and Dr. Shao.

"I tried the titanium clip, but it didn't work?" Yu Xuexian asked.

"Yes, yes." Dr. Shao nodded.

"Then it must be wrong." After listening to Yu Xuexian, he pointed out the problem, that is, he did not find the big fistula.