Selective left gastric vein shunt (coronary shunt)

It belongs to one of the other shunts. The operation is to use the thick left gastric vein and the inferior vena cava to bypass the spleen, and to remove the spleen from the head collateral vessels and the left and right veins. . This procedure has the advantage of distal spleno-renal venous shunt. Treatment of diseases: portal venous rupture Indication Portal hypertension, variceal bleeding, splenectomy and other symptoms. Surgical procedure Intratracheal intubation anesthesia, abdominal and thigh root disinfection cover towel, prepared for autologous great saphenous vein. Take the incision under the left costal margin and extend it slightly to the right from the xiphoid process. After the abdomen, the spleen is removed first, and the length of the vein close to the spleen is reserved. The stomach is pulled downward, and the left and right veins of the stomach are asked to branch the corpus, and the left and right arteries and veins of the gastric retina are separated, and the left gastric artery is disconnected, and only one right gastric artery is retained. After cutting the wall layer and the peritoneum, you can see the reverse blood flow in the left gastric vein. The diameter is 4~6ram, and the length of 3--4era can be applied. After the pressure measurement, the ligation is cut at the proximal portal vein and the other end is temporarily clamped. The peritoneum of the parietal layer was cut open on the outside of the descending part of the duodenum, the duodenum was dullly separated and turned inward to expose the inferior vena cava, and the inner side wall of the exposed inferior vena cava segment was separated by 3 to 4 cm long and The wall of the 1/2 section of the circumference can be placed without damage to the vascular clamp, and the blood flow of the inferior vena cava can be partially blocked. First, the Zhonglian vein and the inferior vena cava were docked with the end socket I (the group was inverted 3 and the right spermatic vein were docked), and the suture was sutured with 6-0 silk thread; because the inferior vena cava pressure was low, the anastomosis was generally not oozing. . The other end of the vein is still clamped to prevent air from entering, and then at the upper edge of the pancreas, the long curved vascular clamp is bluntly separated along the loose tissue gap toward the retina hole. The tunnel is connected to the tunnel through the tunnel bow. l out. The mid-venous stump was trimmed and sutured with a 60-thread intermittently with the appropriate length of the left gastric vein. The anastomosis should be far from the tunnel to prevent the anastomosis from shrinking into the tunnel. After the loose forceps, if there is a small amount of leakage in the anastomosis, no suture is needed, and the hot saline gauze is used to teach the stickers, and generally can stop bleeding. Finally, the pressure of the left gastric vein that initiates the shunt is measured. Postoperative diet Suitable diet: 1, should eat a light liquid diet. 2, do not eat spicy spicy food. 3, avoid drinking alcohol.

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