end-to-side suture

1. The outer diameters of the two blood vessels differ too much, exceeding 1/2 of the outer diameter, and the cut ends are still not able to be sutured at the end. 2. The receiving blood vessel is the only blood supply artery in the receiving area, which will cause limb ischemia or necrosis after cutting. Treatment of diseases: ischemic necrosis Indication 1. The outer diameters of the two blood vessels differ too much, exceeding 1/2 of the outer diameter, and the cut ends are still not able to be sutured at the end. 2. The receiving blood vessel is the only blood supply artery in the receiving area, which will cause limb ischemia or necrosis after cutting. Surgical procedure 1. Exposing and separating the endoscopic suture of the blood vessel. 2. Block the bloodstream side orifice blood vessels with two blood vessel clamps, block the blood flow at both ends of the anastomosis, and the port blood vessels block the blood flow with a blood vessel clamp. 3. The left side of the opener uses the tip of the sacrum to pick up the wall of the side port blood vessel. The left hand is bent and sheared to remove a tube wall to form an elliptical rupture. The circumference of the vessel should be similar to the circumference of the port vessel. 4. The port of the pruning port should be trimmed to a slope of 45° to 60°, so that the two vessels are acutely angled after suturing, the blood flow is large, and eddy current is not easy to form. 5. Stitching, such as sutured blood vessels, can be reversed. When the posterior wall of the anastomosis is clearly visible, the method of end-to-side anastomosis is the same as the two-point method of end-to-end anastomosis. If the anastomotic blood vessels cannot be turned over, there are two methods of suturing: (1) Double-angle suture method: first use double-needle non-invasive needle thread, at the side mouth and port 0 ° and 180 °, suture from the inside to the outside and 1 needle and the second needle, temporarily not tied, reserved for traction. The third needle sutures the midpoint of the posterior wall, the needle is inserted into the outer membrane from the posterior wall of the side port, the needle is released from the endocardium, and the needle is inserted from the inner membrane of the port, and the needle is released from the outer membrane, and the needle is not knotted, and then Between the first needle and the third needle, and between the second needle and the third needle, 1 to 2 stitches are sutured in the same manner, and the suture of the posterior wall is completed. Then suture the sutures in sequence. The anterior wall suture is the same as the end suture. (2) End-to-side suture method: When the small vessel clamp is placed, the two small blood vessel clips of the side mouth are placed parallel to the plane of the anastomosis of the blood vessel, and one blood vessel clip of the port is placed perpendicular to the plane of the anastomosis, and then turned to the left side 90 °. The first needle uses a double needle non-invasive needle thread to suture the lower corner of the port from the inner point to the midpoint of the lower edge of the side port, the upper corner of the second needle suture port and the midpoint of the upper edge of the side port. After knotting, the third needle sutures the midpoint of the right edge of the port and the right corner of the side port. Under traction, between the first needle and the third needle, and between the second needle and the third needle, 1 to 2 stitches are stitched together to complete the right half stitch. Turn the small blood vessel clamp of the port to the right side and suture the left half of the mouth by the same method. The advantage of this method is that the front and back half of the double angle method are changed, and the left and right half mouths are changed without first suturing the rear wall. The operation is more convenient. 6. Remove the small blood vessel clip and restore blood flow.