Fundotomy

With obvious portal hypertension, extensive esophageal and gastric varices, and severe or repeated variceal bleeding, you can seek shunt surgery as soon as possible. The timing of surgery is very important. When emergency hemorrhage, try to avoid shunt surgery. The bleeding should be stopped by conservative treatment. The general condition is better. It is better to perform surgery when the liver function is i or ii (Table 1). In addition, the age is best. Under 50 years old. There are many differences in opinions on preventive diversion, and indications should be more cautious. At the same time of splenectomy, the proximal end of the splenic vein and the left anterior wall of the left renal vein were used for end-to-side anastomosis, so that the high-pressure portal vein blood flowed into the hypotensive renal vein through the anastomosis to achieve the purpose of blood pressure reduction, and also solved the problem of hypersplenism. . However, due to the small anastomosis, stenosis and thrombosis are prone to occur after surgery, and the incidence of hepatic encephalopathy is also high. In recent years, it has been replaced by selective shunt. Treatment of diseases: portal hypertension, portal hypertension, portal hypertension Indication With obvious portal hypertension, extensive esophageal and gastric varices, and severe or repeated variceal bleeding, you can seek shunt surgery as soon as possible. The timing of surgery is very important. When emergency hemorrhage, try to avoid shunt surgery. The bleeding should be stopped by conservative treatment. The general condition is better. It is better to perform surgery when the liver function is i or ii. In addition, the age is preferably under 50 years old. There are many differences in opinions on preventive diversion, and indications should be more cautious. At the same time of splenectomy, the proximal end of the splenic vein and the left anterior wall of the left renal vein were used for end-to-side anastomosis, so that the high-pressure portal vein blood flowed into the hypotensive renal vein through the anastomosis to achieve the purpose of blood pressure reduction, and also solved the problem of hypersplenism. . However, due to the small anastomosis, stenosis and thrombosis are prone to occur after surgery, and the incidence of hepatic encephalopathy is also high. In recent years, it has been replaced by selective shunt. 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, the right waist is about 30°. 2. Incision: mid-abdominal incision or left upper abdomen l-shaped incision. 3. Separation of the bottom of the stomach: After cutting into the abdominal cavity, if the spleen is large and the spleen needs to be cut, the spleen can be removed according to the splenectomy procedure. Then, 5 to 6 cm below the cardia at the bottom of the stomach, the stomach is separated from the large and small bends, and the left gastric vein and the short gastric vein are ligated and cut as much as possible, and the lower part of the esophagus on the cardia is directly reached. 4. Cut the fundus: use two large straight tongs to clamp the bottom of the stomach, traverse the bottom of the stomach between the two tongs, and cut a section of the stomach wall in a wedge shape, then turn up the posterior wall of the stomach at both ends, and sew the stomach wall one by one. The varicose veins on it. 5. Anastomosis of the stomach end: According to the method of gastrointestinal anastomosis, the two ends of the stomach wall were sutured continuously with a full layer of 2-0 gut, and the muscle layer was sutured with a silk thread. 6. Close the abdominal cavity: exhaust the blood in the abdominal cavity, suture the abdominal wall incision layer by layer. If splenectomy is performed at the same time, a cigarette drainage is placed under the left ankle.

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