gastric vein ligation

Basically the same as the shunt, but those who are ineffective in the treatment of acute hemorrhage, especially those with severe disease and poor liver function, should be operated in time. In this critical situation, patients are more difficult to tolerate complicated shunt surgery, only a simple gastric fundus devascularization should be used to prevent rebleeding, and the blood supply to the liver can be improved to prevent hepatic coma. Treatment of diseases: portal hypertension, portal hypertension, portal hypertension Indication Basically the same as the shunt, but those who are ineffective in the treatment of acute hemorrhage, especially those with severe disease and poor liver function, should be operated in time. In this critical situation, patients are more difficult to tolerate complicated shunt surgery, only a simple gastric fundus devascularization should be used to prevent rebleeding, and the blood supply to the liver can be improved to prevent hepatic coma. Preoperative preparation 1. Improve liver function, give high calorie, high protein, low fat, low salt diet and rich vitamins. 2. Strengthen the body's ability to resist disease, such as low plasma protein can be a small amount of fresh or plasma. 3. Correct coagulation insufficiency, intramuscular injection of vitamin k1, vitamin k3, prothrombin and hemostatic agent. 4. Apply antibiotics (neomycin, cephalosporin) two days before surgery to prevent intrahepatic infection and necrosis. 5. Bilateral renal function tests should be performed before surgery. 6. Before the condition, the spleen angiography should be performed before operation. If the venous thrombosis is suspected, the shunt can not be performed. 7. Sodium retention is unfavorable for patients with cirrhosis. Sodium intake should be restricted before surgery. Patients with cirrhosis have increased responsiveness to aldosterone. Therefore, spironolactone can be given before surgery. Surgical procedure 1. Position: supine position, the left waist pad is 30° high. 2. Incision: The median incision in the upper abdomen or the medial incision in the left upper abdomen, the length from the xiphoid to the umbilicus, if necessary, the xiphoid can be cut off to facilitate the display of the cardia. 3. Exploration: After entering the abdominal cavity, explore the size of the liver and spleen, determine the degree of cirrhosis, check the stomach, duodenum with or without ulcers, esophageal lesions, to rule out the bleeding of the two organs. 4. Cut the stomach wall: After confirming that the bleeding comes from the fundus and esophagus, you can open the left lobe of the liver (such as the left liver hypertrophy, you can cut the triangular ligament), reveal the fundus and cardia. In the vicinity of the cardia, the suture is drawn along the anterior wall of the stomach, and then the muscle layer of the sarcoplasmic muscle is cut 5 to 6 cm. After suturing the submucosal blood vessels on both sides of the incision, the mucosal layer was cut and the blood in the stomach was absorbed. After temporarily taking the stomach tube to the esophagus, the gauze is used to block the cardia and the pylorus to keep the stomach clean. Look carefully for active bleeding at the bottom of your stomach. 5. Sewage to stop bleeding: Use a small hook to open the incision of the anterior wall of the stomach to reveal the fundus. After the active bleeding point was found, the silk thread was used for 8-shaped suture or continuous suture to stop bleeding, and all other varicose veins in the fundus area were sutured one by one. Pull the small hook to the upper end of the incision, expose the door of the incision, take out the gauze that blocks the door of the incision, and check whether there is fresh blood flowing out from the lower end of the esophagus. If there is, use the silk thread to break the stitching once, or cut it after sewing. To further block blood flow between the fundus and the esophagus. At this point, active bleeding in the stomach has stopped. 6. Sew the anterior wall of the stomach and sew the coronary vessels: take out the pyloric gauze, re-inject the stomach tube into the stomach, and suture the anterior wall incision. In order to consolidate the hemostasis effect, the coronary veins and the short gastric veins around the stomach, the periorbital and the bottom of the stomach may be sewed or sewed outside and cut off. 7. Stitching: After exhausting the blood from the armpits and checking the gauze and instruments in the abdominal cavity, the abdominal wall incision is sutured layer by layer.