The liver damages and mends _'s treatment method of the skill

The liver damages and mends _'s treatment method of the skill
The liver damages and mends the skill[Adapt to the card ]1.The liver splits and hurts the liver to frustrate and split to injure the damaged area not big, the wound is not deep, organize the little one of necrosis.2.The liver is damaged and is not amalgamating the important person who damages blood vessel in the liver door or liver.[Prepare before the skill ]1.The liver is damaged to diagnose that confirms, should cut open the belly to ascertain. The person who has shock on accompanying, the preparation before do a good job of the skill while resisting shock treatment actively, perform the operation as soon as possible.2.Offer antibiotic, protect the liver medicine, give oxygen, the intestines and stomach reduce pressure etc..[Anaesthetize ]General anesthesia.[Operation step ]The right upper abdomen is cut-outed through the straight skin of belly, is attracting fast behind opening belly, remove it while accumulating blood and clot, verify the liver and damage the situation. Bleed violent, should in charge of, wear the intersection of liver and the intersection of duodenum and ligament, control the first the intersection of liver and door through the intersection of omentum and hole with emulsion first, clear up the liver and damage the wound, does not have life tissue [Fig. 1 to excise ],Pincers insert the intersection of ligature and active the intersection of bleeding and blood vessel and bile duct. Split to shallow liver of table wounded to give the intersection of silk thread and disconnected cotton-padded mattress type, sew and pitch, the distance is 1cm [Fig. 1 by the suture ],Sewing the needle want Damien's crack base bottom, prevent leaving over the dead space, form hematoma or continue taking place and is infected with. Such as to not combing completely or bleeding, can fetch the big omentum to stop up and sew up [Fig. 1 ].The serious liver is frustrated and split wounded, especially when relatively the trunk is damaged or more organized inactivation with the liver, take some often liver, the intersection of liver and section, lobe of the liver or half liver excise. If the condition is critical can't be tolerated and excised, or the total artery of feasible liver (behind sending out the right artery of stomach) when not allowing of condition , the left, right artery of liver, even liver inherent artery ligature, in order to achieve the styptic goal; But cause the danger of liver necrosis to increase sequentially after the above-mentioned ligature. Very critical patient, can adopt the long gauze one and stop up and arrest blood to not arresting blood, build the mouth to draw from the belly wall separately. Should put the rubber tube and make the body posture to guide under the liver.[Attentive matters in the skill ]1.Try hard to excise the organization which lose life so as not to infect, bleed etc. again.2.Break and should pay attention to arresting blood in carefully to the central authorities type liver, avoid sewing up, form the dead space, prevent continuing while taking place the liver from hematoma, infecting, biliary tract bleed. To the persons who there is activity that bleed, can put and guide in and the T -shaped tube of total bile duct is guided.3.Trunk and bile duct should sew, pitch, arrest blood separately, bleed and form gallbladder Lou while being postoperative relatively in the crack.4.Should pay attention to timing while controlling the liver door, there is not liver cirrhosis patient that can block for 25 minutes, should be such that within 15 minutes when there is liver cirrhosis. It is immature while operating to limit in time, can relax for 10 minutes some oppression arrests blood, and then block the liver door for the second time. Pay attention to fully giving oxygen at the same time.5.Except damage blood vessels first and second class at liver,otherwise it if you can't make by lobe of the liver, excises to try not.6.If it can't be styptic to mend the skill simply, when the condition is allowed again, the feasible liver part is excised. Try not to adopt a method to stop up of gauze, because is apt to continue and send out the blood and is infected with. Necessary time spent, should pad a layer of omentums first, in case that gauze one contacts the adhesion with liver directly, cause bleeding while pulling out.7.While accumulating the blood and is mixed with the bile in the abdominal cavity, unless there are seriously fatal shock, the persons who do not there is not a blood source, it is generally unsuitable to use own blood transfusion.8.In order to appear the skill is wild, can cut off all ligaments of the liver if necessary.[Skill aftertreatment ]1.The amount of blood pressure, pulse and urine paid attention to, determine hemoglobin and blood count are pressed and accumulated, observe the supplementary information of the blood capacity.2.Notice that guides property and quantity of the liquid under the liver, observe and continue bleeding and gallbladder Lou and take shape. Pull out the drainage tube in right time.3.Determine liver function and employ protecting the liver medicine, especially to amalgamating the persons who have blocked the liver door in liver cirrhosis or skill. Give oxygen resume so as to liver function continuously in the 48 hour.4.Employ antibiotic, prevent from and is infected with under the diaphragm.5.Guide when being the bile in the liquid, pay attention to having peritonitis to behave. Pay attention to fully guiding.
|