Thoracic and abdominal combined incision

Applicable to lower chest, upper abdominal surgery, such as chest and abdomen combined surgery, cardia cancer surgery.

Treating diseases: cardia cancer

Indication

Applicable to lower chest, upper abdominal surgery, such as chest and abdomen combined surgery, cardia cancer surgery.

Contraindications

1. The blood coagulation mechanism has serious obstacles.

2. Hypertension, diabetes, and some bleeding-prone diseases.

Preoperative preparation

1. According to general nursing routine before general surgery.

2. Guide lung function training to prevent colds and prevent postoperative pulmonary complications.

3, according to the surgical site for skin preparation

(1) posterior external incision: the median line of the anterior chest to the posterior spine line, including the underarm, from the horizontal line of the clavicle to the xiphoid.

(2) Median incision: the posterior chest to the posterior line to the right posterior line, including bilateral underarms.

(3) Three incisions of the esophagus: left neck, right chest (same posterior incision), abdomen (including umbilicus, perineum).

(4) chest and abdomen combined incision: left chest (same posterior incision), left upper abdomen.

4. After the patient is sent to the operating room, prepare the monitoring instruments and routine rescue items.

Surgical procedure

1. Incision: Starting from the posterior tibial line, the rib arch is advanced forward and downward along the 8th or 9th intercostal space, and then extended to the midline of the upper abdomen (Fig. 2).

2. Cut the anterior serratus, the external oblique muscle aponeurosis, and the rectus abdominis sheath, and cut into the chest through the intercostal space.

3. Cut the rib arch (Fig. 3), cut the transverse abdominis muscle and the peritoneum into the abdomen.

4. Cut the diaphragm (Fig. 4) and place the chest opener to open the intercostal space.

5. Suture incision: the diaphragm was sutured intermittently on line 10, a closed drainage tube was placed in the pleural cavity, and the intercostal incision was sutured. The peritoneum was sutured continuously, the rib arch was sutured on line 10, and the chest wall and abdominal wall incision were sutured layer by layer (Fig. 5).

complication

Incision infection.

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