Mend _'s general knowledge of the skill in stomach duodenum perforated ulcer

Mend _'s general knowledge of the skill in stomach, duodenum perforated ulcer
It is to perform the operation and mend or excise to mend the with therapeutic perforated ulcer traditional idea to stomach, duodenum in the past of the skill in stomach stomach, duodenum perforated ulcer immediately. With the development of acute abdomen of therapy of combining traditional Chinese and Western medicine, this kind of idea has already changed to some extent now, perform the operation getting therapeutic to increase gradually, surgery meet card already gradually limitation. Sew up and punch in the place Cover the big omentum 1st gastric ulcer of big fixed omentum picture punches and mends the skill Fig. 2 imbeds and mends the skill more than the big omentum of big perforated ulcer Rhombus excises ulcer Walk crosswise and sew up the coat of the stomach to cut-out Cover the 3rd bigger gastric ulcer of big omentum picture and punch and excise and sew up the skill Ulcer position Rhombus excises ulcer, lengthen and cut-out Walk crosswise and sew up the intestines wall to cut-out Cover big the intersection of omentum and the intersection of picture and 4 great the intersection of duodenum and perforated ulcer excise, sew up skill [card of adapting to ] according to the intersection of Dalian and medical university and the intersection of Tianjin and the intersection of the south and day the intersection of hospital and the intersection of therapy of combining traditional Chinese and Western medicine and anxious belly The experience of disease, make the adaptation card of surgery treatment (including gastrectomy) as follows : 1.Patient's general situation is not good, with suffering from shock or and have heart, lung, liver, kidney,etc. important internal organs pathological change, and the serious one rotates gradually in peritonitis. 2.Complexity punch( Such as cancerous swelling, bleed, obstruct) Or there are persons who need to perform the operation immediately of other acute abdomens. 3.Peritonitis is serious, the abdominal cavity accumulates the liquid more, intestines paralysis is serious, abdominal distension and poisoning the obvious one of symptom. 4.The treatment adapts to the card treatment 6 according to perform the operation non-- 12 hour ( Generally less than 12 hours) And then, the persons who disappear and relieve of symptom, physical sign or aggravate. 5.Above the age of 40, stubbornness ulcer that have longer medical histories, doubt and gastric ulcer there are malignant pathological changes, and the persons who punch on a full stomach, can consider the surgery treatment. [Prepare in front of the skill ] patient getting bad general situation have, should carry on, plan in front of the appropriate skill(if employed antibiotic, the intestines and stomach reduce pressure, correct water, electrolytic equilibrium and lack proper care, supplement blood capacity,etc.) ,Can carry on the operation after taking a favorable turn in condition. If the patient has already presented poisoning shock, should carry on the operation in time after being in positive preparation for 1- 2 hours. [Anaesthetize ] in order to strengthen, add office to be rough senior or weak patients; Abdominal distension, intestines paralysis are serious, there are the possible one vomited or sucked the vomit by mistakes, should be by anaesthetizing in the trachea; The tense one of abdominal muscle between twenty and fifty, should select for use and anaesthetize outside the hard membrane. [Operation step ] 1. Body posture It is flat to lie in the location 2. Cut-out and generally adopt the centre of upper abdomen to cut-out; Doubt and the persons who punched of gastric ulcer before the skill, can cut-out through the straight skin of belly with the left side; Doubt and the intersection of duodenum and perforated ulcer person, can cut-out by the intersection of belly and frank skin with right side. Cut the peritoneum, exhaust abdominal cavity's inner liquid. 3.Sew up and punch and punch in the wall before the stomach, duodenum more, is often having fibrin that oozed out things to deposit to punch somely, there can be liquid and bubble ease that produce to pinch the stomach, generally easy to find. The place is covered glueing by big omentum, liver, gallbladder,etc. to punch sometimes, can appear after separating gently. The wall has not found and punched as before, should cut and whet the appetite the colon ligament, check the back wall of the stomach. Surrounding tissue texture very hard and light to punch, can spend the silk thread of medium size along the major axis of coat of the stomach, cross over and punch in the place and make one layer of disconnected stitches and 3- 4 stitch [Fig. 1s of skin of thick liquid ]; If 12 points the intestinal perforation, the suture should run through the whole storey of intestines wall. Then, the ligature one by one, close and punch carefully. The suture wouldn't be cut off. 4.The place is covered to cover the big omentum and draw the large omentum to punch, then fix ligature loose of suture [Fig. 1 ]. Should not the intersection of ligature and high strung, big omentum so as not to cause have necrosis more ischemic. 5.Exhaust the intersection of abdominal cavity and inner liquid, check, punch, sew up appropriate, check and exhaust in the abdominal cavity again (and the pelvis especially under the liver) Ooze out liquid and food residue. 6.Sew up, sew up peritoneum, the intersection of belly and sheath, hypodermis and skin around the frank skin according to layer. Heavier to pollution, should put in the abdominal cavity cigarettes are guided or the soft rubber is in charge of guiding, put the rubber one to guide under the cover. [Attentive matters in the skill ] 1. Wear near hole to organize generally having the intersection of inflammation nature and edema, relatively hard fragile, should punch sew up, more normal coat of the stomach organize enterprising stitch around. Enter needle, take wide dark, want, relax to lead, leave behind, go on slowly stomach when the ligature, but can't pitch high strung, in case that the suture isolates the organization. 2.To punching bigger, the punching department organizes fragily, the simple stitch has difficulties or simple stitches that the one who obstructs will happen, it can pierce through suture first,wouldn't ligature,if you can't bring by base of a fruit or large omentum free, last of punching together, then ligature is closed [Fig. 2 ]. 3.If it is old for gastric ulcer to punch, cicatrix hard, should act as rhombus, excise the intersection of ulcer and the intersection of and coat of the stomach first, then walk crosswise and sew up, and cover the big omentum [Fig. 3 - ],Can't use and sew simply and mend legally. 4.If duodenum perforated ulcer is big, cicatrix is hard, ulcer, close to the pylorus person, making rhombus should be lengthened from the angle column of both sides and cut-outed after excising, and then walk crosswise and sew shaping skill of the cooperative pylorus [Fig. 4 - ],So as not to cause pyloric stenosis. 5.If suspect there is ulcer while erupting malignant pathological change simultaneously, should be punching and fetching and organizing doing icy cut sections for microscopic examination living. If pathology proves malignantly, when patient's situation is allowed, should excise according to gastric carcinoma. [Skill aftertreatment ] 1. Postoperative ( The general anesthesia patient is after waking up) Adopt half a seat, so as not to play abscess. 2.Postoperative fasting, continue the intestines and stomach and reduce pressure, the intravenous infusion maintains nutrition, generally the intestines wriggle and resume after the 2nd - 3 days, can pull out the stomach tube, begin to enter the diet of liquid. 3.Employ antibiotic, prevent infecting. ]]
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