Transabdominal fundus seromuscular incision and suture of varicose vessels

Transsphenoidal fundus incision variceal suture 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 Intra-abdominal gastric fundus incision varicose suture 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 1. Incision: A transverse incision or an "L" shaped incision in the upper abdomen. 2. Routine removal of the spleen after laparotomy. 3. The stomach contents are pumped through the stomach tube, and the stomach is bent down to make the stomach flatten. 5cm away from the cardia, cut the muscle layer of the stomach wall, pay attention to protect the mucosa and prevent the mucosa from being cut. 4. The bleeding point of the sarcolemma layer and the varicose blood vessels attached to the mucosa are respectively sutured with a silk thread. 5. Reverse the stomach and treat the blood vessels under the mucosa of the posterior wall in the same way. The muscle wall of the gastric wall was then sutured intermittently. 6. Cut the gastric coronary vein on the small curved side of the stomach. At the same time, the small curved side of the gastric pulp muscle layer is cut and splayed, and the bleeding is severe when the muscle layer is cut. The upper and lower ends can be clamped with the intestinal clamp to make the surgical field clear. After the ligation of the blood vessel, the incision of the small curved muscle layer of the stomach was sutured with a 2-0 silk suture. If the spleen has been removed during the operation, the omentum should be included at the same time, so that the collateral circulation can be formed after surgery, reducing the chance of rebleeding.

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