endoluminal esophagogastric vein ligation

Intracavitary esophageal varices ligation 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: upper gastrointestinal bleeding in portal hypertension Indication Intracavitary esophageal varices ligation is applicable to: 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. The seventh intercostal long incision on the left side of the incision. 2. After opening the chest, push the lungs upwards, cut the lung ligaments, and separate the diaphragmatic and esophageal hiatus. Cut the diaphragm on the left side of the hole and expose the lower part of the esophagus and the fundus. First, the lower part of the esophagus above the diaphragm was cut 5 cm long, and a traction line was sewed on both sides of the incision. After the esophagus is opened, the blood and blood clots are quickly removed by the suction device, and the blood is stopped by the warm saline gauze. Retracting the incision of the esophagus reveals a large, distorted varicose vein. The blood vessels were sutured in 3-0 absorbable sutures. If the rupture is at the fundus, the esophageal incision can be extended to the fundus by the cardia for 3 cm, and the rupture is found. Except for suturing the bleeding vein, the remaining varicose veins are sewed one by one. 3. Repeat the examination of the surgical field, and be sure to sew all the varicose veins under clear vision. Finally, the esophageal incision was sutured with a 2-0 silk thread or a 4-0 absorbable suture, and a layer of muscle was sutured. The incision of the diaphragm is sutured. 4. Place a closed drainage tube in the chest. The chest wall is then sutured layer by layer.

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