intubation suture

In 1978, Lauritzen reported that the suture method was used to achieve good results, and the suture method was continuously improved in the future. It has been widely used in clinical practice, and its success rate is similar to end-to-end suture. The blood vessel that is inserted into the suture must be normal and of sufficient length for the socket. In addition, the outer diameters of the two blood vessels that are inserted into the suture must be similar and cannot be too different. Treatment of diseases: intestinal vascular malformations Indication The blood vessel that is inserted into the suture must be normal and of sufficient length for the socket. In addition, the outer diameters of the two blood vessels that are inserted into the suture must be similar and cannot be too different. Contraindications 1. Nesting suture can only be used for end-to-end suture, and should never be used for end-to-side suture. 2. After the two blood vessels with large difference in outer diameter are sleeved, it is easy to cause the lumen to block, or the insertion end to escape. Surgical procedure (a) Lauritzen nesting method 1. Separate the blood vessels, place the small blood vessel clamp and the micro-closer, and cut off the blood vessel equivalent end-to-end anastomosis. 2. According to the direction of blood flow, determine the nesting end and the sheath end. Generally, the proximal end of the artery is the nesting end, and the distal end is the sheath end; the vein is opposite, the distal end is the nesting end, and the proximal end is the sheath end. 3. Peeling the outer membrane: The method of peeling the outer membrane is the same as the end end, but the length of the outer membrane peeling off the end of the sheath should be twice the outer diameter of the blood vessel, and it is completely peeled off to reduce the thickness of the blood vessel wall. 4. Enlarge the sheath end: insert the tip of the sheath into the lumen of the sheath end, gently enlarge, so that the lumen of the sheath end is larger than the nesting end, and close the micro-closer to make the two ends meet. 5. Stitching: The first needle is at 0° of the root of the nesting end, only the suture and the outer membrane and part of the muscle layer from the outside to the inside, and the needle is not passed through the inner membrane; the same needle is used at the end of the sheath sheath The needle is inserted from the inner membrane at a 0° of about 0.2 mm, and the needle is passed through the outer membrane. In the same manner, the second needle was sutured at 180° from the sheath end tube at 180° of the root of the nesting end. After the two needles are sutured, they are knotted separately. 6. Insert the nesting section: After suturing the two needles, the nesting section can be overlapped on the front or the back of the sheathing end. The operator holds the edge of the sheathing end of the sheath with a pair of tweezers and gently lifts it up to show the sheath. The lumen of the end. The other hand uses a forceps to gently insert the sleeve into the lumen of the sheath. After the nesting, the surgeon uses the microscopic tissue forceps to pinch the vascularized part of the blood vessel, and flattens it so that the nesting section and the sheathing section are in close contact, so as to prevent the blood from entering the interlayer and forming a thrombus after the blood flow is restored. 7. Restore blood flow: remove the small blood vessel clips in sequence to restore blood flow. If the operation is correct, there will be a slight oozing after the blood is passed, and it can be stopped by pressing the saline cotton ball for a while. (2) Improved nesting method On the basis of the Lauritzen nesting method, Chinese scholars have proposed many improved methods. The following two methods are introduced: 1. Three-point nesting method: This method is the same as the three-point stitching method of end-to-end anastomosis, that is, at the root of the nesting end and the end of the sheath end, one stitch is stitched every 120°, and three stitches are stitched together, and the third stitch is used. After sewing, do not tie knots, wait until the sleeves are inserted, and then knot. The advantage is that the length of the insertion section is short (1.2 to 1.5 times of the outer diameter of the blood vessel), which is easy to be inserted, and the insertion section is not easy to escape. The disadvantage is that the fixed point stitching is not easy to be accurate, and the stitch length is uneven. 2. Incision and suture method: This method first makes a longitudinal incision at 90° of the sheath end, and its length is equal to or slightly larger than the outer diameter of the blood vessel. At the time of suturing, the apex of the sheath end cut is sutured at 90° at the nesting end, and the entangled end is pulled into the sheath end after knotting. The anastomosis was inverted by 180° and the posterior side of the nested end was inserted. The whole layer is sutured at 270° of the sheath end. After the needle is taken out, the same needle is used to hang the outer membrane and part of the middle membrane at 270° of the root of the nesting end. After knotting, the nesting end completely enters the sheathing end. . The anastomosis is turned over again, and the two sides of the wall of the tube wall are sutured in a full layer, and the outer membrane and part of the middle membrane of the corresponding part of the section are sutured, and the incision part of the blood vessel is repaired after the knotting, and the suture is completed. The advantage of this method is that it is easier to insert, and it is not easy to escape. The disadvantage is that the wall of the tube is cut and the damage of the tube wall is increased.