retroperitoneal laparotomy

Posterior abdominal laparotomy is an examination and/or treatment used by general practitioners to find the cause or determine the extent of the disease and to take appropriate surgery. Treatment of diseases: acute abdomen gastrointestinal bleeding Indication Abdominal injury, acute abdomen, acute gastrointestinal bleeding and abdominal mass. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation 1. Dehydrated patients should be infused with saline quickly to correct water and electrolyte imbalance. 2. In addition to infusion of normal saline, blood loss patients need to quickly supplement whole blood, plasma, dextran and other expansion agents. 3. Patients with long course of disease should be supplemented with potassium ions. 4. Gastrointestinal decompression, eliminate abdominal distension, to facilitate intraoperative operation and postoperative recovery. 5. Use antibiotics to prevent infection. 6. Calm and relieve pain, so that the patient's spirit is peaceful. 7. Prepare blood. Surgical procedure 1. Position: lumbar anesthesia, epidural anesthesia for 6 hours, general anesthesia to patients wake up, blood pressure can be changed to a semi-sitting position, so that the inflammatory fluid is concentrated in the pelvic cavity. Because the absorption of the pelvic peritoneum is worse than that of the upper abdomen, it can alleviate the poisoning reaction. Once the pelvic cavity forms an abscess, it is also easy to be used for incision and drainage. At the same time, the semi-sitting position can also reduce the impact of abdominal distension on breathing and circulation. 2. Closely observe body temperature, pulse and breathing, and actively prevent and treat shock. 3. Fasting, gastrointestinal decompression, recording liquid intake and withdrawal during fasting, intravenous infusion, recovery and maintenance of water, electrolytes and acid and acid balance. Gastrointestinal decompression to recovery of intestinal peristalsis, anal discharge. After the stomach tube is removed, the fluid can be started and gradually changed to semi-liquid and general food. 4. Disarm bloating as soon as possible: gently massage the abdomen; acupuncture at Zusanli, Shangyu, Zhongmu, Tianshu, Hegu and other points, help to prevent abdominal distension and intestinal paralysis. Application of traditional Chinese medicine gastrointestinal recovery soup (raw scutellaria 15g ginseng 10g stalk 10g peach kernel 10g oyster shell 10g rhubarb 15g fried raisin 20g guangmuxiang 10g red peony 15g dandelion 30g) 1/4 agent decoction injected through the stomach tube, each 2 to 4 times a day, for 3 consecutive days, after defecation more than 3 times a day, reduce or stop the drug. If the bloating is not relieved after the above treatment, it is feasible to use anal canal or low-pressure enema. If the gastrointestinal tract is not involved during the operation, the neostigmine 0.5-1mg can be applied as early as possible to close the Zusanli acupoint on both sides to promote the recovery of intestinal peristalsis. 5. Use antibiotics: It is best to use antibiotics based on the pathogens cultured in the peritoneal exudate and the sensitivity to the drug to control the infection. It is generally possible to use penicillin plus streptomycin or chloramphenicol, or gentamicin, and to use metronidazole. 6. The abdominal drainage tube is connected to the drainage bag or the sterilizing bottle to record the flow. Change the dressing in time, keep the lead flow smoothly, turn the cigarette drain strip every day, pull out a little, and generally do not remove it after 4~5 days. complication Postoperative infection.