Exploratory Laparotomy

Exploratory laparotomy is an examination and/or treatment for finding the cause or determining the extent of the disease and then taking the appropriate surgery. Due to economic and social development, abdominal injuries have increased, coupled with acute abdomen, acute gastrointestinal bleeding and abdominal masses, laparotomy has become a common type of surgery in primary hospitals. Basic Information Specialist classification: Digestive examination classification: other examinations Applicable gender: whether men and women apply fasting: fasting Analysis results: Below normal: Normal value: no Above normal: negative: There were no abnormal bleeding symptoms and no abdomen in the abdomen. Positive: For patients with abdominal injuries, the location, extent and extent of the injury should be determined and disposed of. Tips: After the evening of 8:00 on the previous day, you should fast, gastrointestinal decompression, and record the amount of liquid in and out. Normal value There were no abnormal bleeding symptoms and no abdomen in the abdomen. Clinical significance Abnormal results: (1) For patients with abdominal injuries, the location, extent and extent of the injury should be determined and disposed of. Spleen rupture and spleen suture repair or resection; liver rupture suture repair, wedge resection or hepatic resection, if the patient's condition does not allow liver resection and other methods can not stop bleeding, hepatic artery ligation can be performed; Repair or resection; severe colon injury should be performed first. (2) For patients with peritonitis, eliminating the source of inflammation is a major aspect of treatment. Such as appendicitis, Meckel diverticulitis should be removed as much as possible; cholecystitis, cholangitis should be sputum drainage; gastrointestinal perforation should be suture repair or resection. If it is primary peritonitis, the pus should be aspirated as much as possible, the abdominal cavity should be cleaned, and cigarettes should be placed in the lower abdomen. (3) Upper gastrointestinal bleeding should be sutured or resected according to the cause of bleeding to achieve the purpose of stopping bleeding. 1 can not be removed ulcer bleeding, simple suture can not guarantee no longer bleeding, should be as far as possible to remove the ulcer outside the gastrointestinal, and cover the ulcer with surrounding tissue, plus a major gastrectomy to ensure no longer bleeding. 2 esophageal varices bleeding in the bottom of the stomach vascular ligation, the recent effect is not certain, should be added splenectomy or gastric transection. 3 biliary tract bleeding after the common bile duct drainage to stop bleeding, but the effect is not certain. If there is a large amount of blood in the gallbladder, the gallbladder should be removed while the common bile duct is drained, and the hepatic artery should be ligated. 4 sputum or high position small curved ulcer bleeding, for upper gastrectomy, abdominal incision should be changed to chest and abdomen combined incision, the diaphragm is cut, the lesion is removed, the stomach is lifted into the chest, and the lower end of the esophagus. If the probe is negative, blind abdominal resection is not enough, because superficial ulcers, hemorrhagic gastritis and other lesions often spread throughout the stomach, the removal of part of the body can not stop bleeding. If the lesion is not within the scope of resection, it will not be able to stop bleeding. Blind resection will increase the unnecessary burden of the patient and make the already critical condition worse. If necessary, vagus nerve cutting and pyloric angioplasty can be performed, and the effect can be observed. (4) For the treatment of abdominal masses, the process of actually separating the masses is the process of excision. After the exploration is completed, the tumor can be removed or the disease that has been confirmed can be removed, or the operation can be stopped without clearing the tumor. For the surrounding tissue connected to the mass, when it is damaged during the exploration and separation process, it should be treated according to the principle that it can be supplemented and replenished. If the common bile duct or ureter is damaged and cannot be end-to-end anastomosis, a free segment of the intestine can be used instead. If the blood vessel is damaged and the end end is not matched, the artificial blood vessel can be used instead. (5) patients with intestinal obstruction should be treated according to the cause of the disease, such as adhesion loosening, nesting and returning, torsion reduction, internal hemorrhoids and repair, tumor resection caused by obstruction or clear necrotic bowel resection. Due to the severe extensive adhesive intestinal obstruction caused by multiple operations, small intestine folding should be considered after separation of adhesions and obstruction. All small intestinal necrosis is most difficult to treat due to total small intestine torsion. If it is indeed necrotic, only the resection can temporarily save the life, and then according to the survival of the small intestine tube for reverse surgery, or artificial sphincter surgery. In order to ensure that the repaired and resected anastomosis of the intestine is well healed, the decompression of the intestine should be considered. The proximal end of the gastrointestinal decompression tube can be passed through the pylorus, from the upper to the intestine requiring decompression; the lower end of the intestine can be inserted into the stomach. The intestinal decompression tube is introduced into the intestinal tube requiring decompression through the ileocecal valve to ensure that the local part does not swell and rupture into a sputum. All aphids in the small intestine should be removed through a decompression or pushed into the colon to prevent the anastomosis from being broken due to aphid activity. People who need to be examined have syncope, cold limbs, low urine, irritability, and a mass in the abdomen. Positive results may be diseases: endometrial tuberculosis, lymph node-biliary syndrome, gastrointestinal tract foreign body and foreign body intestinal obstruction, small intestine adenocarcinoma, small intestine carcinoid, intestinal betel disease, ovarian cyst, cholangiocarcinoma, pediatric hypospadias , small intestine primary malignant lymphoma considerations Taboo before the examination: After 8:00 pm on the day before the examination, the patient should be fasted, gastrointestinal decompression, and the amount of liquid in and out. Requirements for inspection: Checking for relaxation, checking may cause physical and psychological burdens, should be actively faced, and actively cooperate with the inspection. If the incision is infected, it should be drained as soon as necessary. Inspection process The general abdominal exploration sequence is as follows: Liver: Slide your hand on the exposed liver surface, touch the toughness, and cooperate with the visual inspection to detect whether the liver is damaged, inflammation, cyst, cancer, hardening or stone. Esophageal hiatus: For patients with pain and swelling in the upper abdomen, it is necessary to explore the esophageal hiatus. Some patients with esophageal hiatal hernia may present these symptoms. First pull the left lobe of the liver to the upper right side with a hook and push the stomach flap to the lower left side with your hand to reveal the cardia. Then use the right finger to palpate whether there is an intra-abdominal organ through the esophageal hiatus into the chest cavity, pay attention to the presence or absence of tumors and inflammatory lesions; and pay attention to the left lobe of the liver with or without tumor and metastatic cancer lesions. Spleen area: patients with abdominal trauma should be routinely examined for the spleen area. The subperitoneal rupture of the spleen does not necessarily show hemorrhage in the abdomen. Only when the spleen is palpated, the subcapsular hemorrhage is found. At this time, spleen suture repair or resection should also be performed. In addition, it is necessary to check the lesions of the spleen of the colon with or without tumors. Stomach: Use the right hand to palpate the entire anterior wall of the stomach from the cardia to the pylorus, the size of the curve, the omentum and lymph nodes. Then make a mouth under the small omentum, and separate the gastric colon ligament from the big curvature of the stomach, and probe the posterior wall of the stomach and the stomach bed itself. Duodenum: Go to the right along the pylorus and explore the presence of ulcer lesions in the duodenal bulb. Penetrating ulcers often have heavier adhesions, and perforated ulcers are surrounded by pus and exudate. Biliary tract: first check the size and tension of the gallbladder, whether there is adhesion, edema, suppuration, gangrene, and whether there are stones in the cavity. Then, use the left hand to extend into the omentum hole, palpate the thickness of the common bile duct, with or without stones, surrounded by swollen lymph nodes, adhesions or masses. Pancreas: Lift the transverse colon and press the head, body and tail of the pancreas at the base of the transverse mesenteric finger with your hand pointing upwards and backwards to understand the hardness, presence or absence of nodules and masses. The body part of the pancreas was examined at the incision of the gastric ligament. If necessary, the duodenal descending portion can be separated to reveal the head of the pancreas. Small intestine: The transverse colon and its mesentery are pulled upward, and the duodenal suspensory ligament (Treitz ligament) is diagnosed. The duodenal jejunum is presented. According to the condition, the ileocecal valve is inspected from the beginning of the jejunum. While examining the small intestine, check the corresponding mesenteric for blood circulation disorders. During the examination, the examined intestines should be returned to the abdominal cavity in time. Appendix and ascending colon: Pay special attention to the appendix when acute peritonitis. First find the ileocecal area, look for the appendix to the cecum, and you can see the appendix. Then, explore the ascending colon and pay attention to the right kidney and right ureter with or without lesions. Transverse colon and omentum: lift the omentum and the transverse colon upwards, check the omentum for necrosis or metastasis, sometimes the omentum and other organs are stuck, and also need to check for possible internal hemorrhoids and intestinal obstruction. Wait. From the liver to the spleen, the transverse colon was examined for tumor, stenosis or obstruction. Colon, colon and rectum: focus on the presence or absence of stenosis, obstruction, mass, inflammatory lesions and diverticulum, and at the same time explore the left kidney and ureter. Bladder, uterus, and appendages: The surgeon puts the hand into the pelvis and examines the bladder. Women must check the uterus, fallopian tubes and ovaries; in the case of suspected ectopic pregnancy, the attachment must be checked. Not suitable for the crowd Contrained people: people infected with wounds. Adverse reactions and risks Nothing.