Sugiura surgery

Sugiura surgery is used for emergency surgery for acute massive hemorrhage of portal hypertension. Portal hypertension is the result of impeded blood flow to the portal system. The main clinical manifestations are congestive splenomegaly, hypersplenism, gastric fundus and esophageal varices, and a large amount of hematemesis after varicose vein rupture, which can be life-threatening. It can also cause ascites. Treatment of diseases: portal hypertension Indication Sugiura surgery is suitable for: 1. Upper gastrointestinal bleeding of portal hypertension is not effective after medical treatment. 2. The sick child is generally in poor condition and cannot tolerate shunt surgery or is too young to be suitable for shunt surgery. 3. If the child has ascites, you can choose to pass the thoracic esophagus. 4. If there is no ascites, gastric fundus ligation can be performed through the abdominal cavity. Preoperative preparation 1. Upper gastrointestinal bleeding occurs, and blood volume should be supplemented during non-surgical treatment to prevent hemorrhagic shock during operation. 2. If the liver function of the sick child is not good, attention should be paid to liver protection to prevent hepatic coma after operation. 3. Apply antibiotics to prevent infection. Surgical procedure Incision On the left side of the 7th intercostal space, remove the 7th rib to enlarge the incision and increase exposure. 2. Esophageal sinus After the chest is opened, the mediastinal pleura is opened and the aorta is separated from the anterior direction. The esophagus is dissected, and the free range includes from the esophageal hiatus up to the lower pulmonary vein. Free the vagus nerve next to the esophagus, but not cut. All the branches of the esophageal vein leading to the esophagus were ligated and cut, and the ligation and interruption were from the esophageal hiatus to the inferior pulmonary vein. A total of about 40 to 50 branches had to be ligated. The vagus nerve and the esophageal vein should be protected during surgery. 3. Gastric regurgitation and splenectomy (1) Open the diaphragm 2 to 3 cm behind the vagus nerve. When the diaphragm is cut, the bleeding points on both sides of the incision are sutured one by one to prevent bleeding. (2) After entering the abdominal cavity, free spleen ligament, spleen and stomach ligament, spleen colon ligament and spleen and kidney ligament, routine removal of the spleen, because there may be a rich collateral circulation around the spleen, it should pay attention to stop bleeding in the operation. (3) After the spleen is removed, the blood vessels that enter the stomach from the upper part of the stomach and the stomach are ligated one by one until the left vascular of the gastric retina. On the small curved side of the stomach, the branches of the gastric coronary veins are ligated, and the branches from the esophagus to the branches of the stomach wall are ligated to achieve the purpose of interruption. Following the high-selective vagus nerve ablation, the blood vessels in the upper segment of the stomach are 6 to 7 cm long. 4. Cut and re-synchronize the lower esophagus The non-invasive vascular clamp was used to clamp the two ends of the esophagus at the distal end of the junction of the heart and the esophagus. The muscle layer of the esophagus was cut between the two clamps, and the muscle layer was separated slightly, and then the adhesive was cut. The cut esophageal vein was ligated. 5. Esophageal end anastomosis The mucosa and submucosa were sutured intermittently with a 5-0 silk thread, and then the muscle layer of the esophagus was anastomosed with a 2-0 silk thread. These anastomotic sutures further sewn the varicose esophageal vein. 6. Stitching and drainage Place the closed thoracic drainage tube and suture the mediastinal pleura and diaphragm. The diaphragm should be sutured very tightly to prevent ascites from flowing through the incision into the chest.

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