Transthoracic ligation of lower esophagus and fundus varices

Direct angiography confirmed that the esophageal drainage vein began at the left lower pulmonary vein and reached the lowest stomach. Therefore, it is necessary to completely remove the varicose veins in the bottom of the stomach below the plane of the left lower pulmonary vein, especially the esophageal vein within 10 to 12 cm above the hiatus, in order to truly achieve the purpose of portal venous interruption. This can only be done with surgery that is performed by the lower transesophageal esophagus and the varicose veins of the fundus. Treatment of diseases: esophageal varices and rupture of bleeding antral vasodilatation Indication Those who are ineffective in the treatment of acute hemorrhage, especially those with severe disease and poor liver function, should be operated promptly. 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. Contraindications 1. Patients with suspected supraclavicular lymph node metastasis, liver metastasis, lung metastasis, abdominal metastases, and ascites. 2. The cancer has directly invaded the adjacent organs, and has formed a complication of esophagus, tracheal fistula, lung abscess, mediastinal inflammation, abscess and the like. There is cachexia, especially those with high cachexia. Preoperative preparation 1. Give high sugar, high protein, high vitamin, low salt and low fat diet. For patients with poor appetite, appropriate parenteral and enteral nutrition support should be given, such as intravenous supplementation of GIK fluid and branched-chain amino acids to enhance nutrition and improve general condition. 2. Patients with major bleeding, if there is moderate anemia and obvious hypoproteinemia, an appropriate amount of fresh whole blood and human albumin or plasma should be intermittently infused 1 week before surgery. 3. In addition to the use of general liver protection drugs, hepatocyte growth factor, hepatocyte regenerating factor, and glucagon may be used if necessary. 4. Improve the coagulation mechanism. One week before surgery, routine intramuscular or intravenous injection of vitamin K11. For patients with prolonged prothrombin time and significantly lower platelet count, conditional preoperative injection of platelet suspension, cryoprecipitate or freshly lyophilized plasma (precursor containing various clotting factors and Fibronectin). 5. Prophylactic antibiotics. One dose should be given 30 minutes before surgery, and 1 to 2 doses should be used for intraoperative use. Antibiotics should be selected from a broad spectrum of drugs, such as aminoglycosides, cephalosporins; and anti-anaerobic drugs such as metronidazole or tinidazole. 6. Digestive tract preparation: patients with esophageal transection should be treated with 0.1% neomycin gargle and oral administration before surgery to clean the mouth and esophagus; clean enema should be cleaned before surgery, or can be heated with 25 to 50 g of magnesium sulfate powder. Mix 1500ml of boiling water, clean the intestines to avoid enema; place a thin and soft nasogastric tube 30 minutes before surgery. Before placing the tube, take oral liquid paraffin 30ml to lubricate the esophagus. 7. In general, catheterization should be left before surgery. Surgical procedure 1. Position: The right lateral position, the left upper arm is fixed on the head bracket of the operating table. 2. Incision: posterior lateral incision of the left chest, remove the 8th rib on the left side, or directly cut the 7th intercostal space into the chest. 3. Expose the lower part of the esophagus: push the left lung upwards, cut off the lower ligament of the lung, separate the pleural ventricle of the lower mediastinum, and reach the hiatus of the diaphragm of the diaphragm. Pull it with a suture thread. The left diaphragm was separated and the left side of the hiatus was dissected, and the lower esophagus, cardia and fundus were exposed. 4. Cut the lower part of the esophagus: After separating the lower part of the esophagus, pull it out with two gauze, and cut the wall of the tube about 5 cm in a longitudinal direction. 5. Sewage varicose veins: Two traction lines were sutured on both sides of the esophagus cutting edge, and the varicose veins of the large esophageal sputum were revealed and sutured with silk thread. Generally, 3 rows can be sewed, each row being about 5-6 cm long. If the fundus also has varicose veins, the esophageal incision should be extended 3 to 4 cm to the fundus, and the varicose veins of the fundus should be found. 6. Suture the esophagus and fundus, and close the abdominal cavity: suture the lower esophagus and the fundus incision in two layers, repair the mediastinal pleura, suture the chest wall and abdominal wall incision, and place the thoracic drainage tube between the 9th intercostal space. complication The treatment of esophageal varices and partial splenic artery embolization has clear curative effect and no major complications.

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