Surgery for proximal hepatic vein injury

Surgery for hepatic trauma is used for surgery for hepatic trauma. Near hepatic vein injury refers to the damage of the main hepatic vein and the posterior inferior vena cava. Due to the special anatomical location of the posterior hepatic region, it is difficult to treat. So far, hepatic vein injury is still one of the most difficult problems in the field of liver surgery. Treatment of diseases: portal vein thrombosis Indication When the hepatic vein is damaged, such as the patient's shock is not easy to correct, in the surgical exploration, the partial compression or hepatic occlusion of the gauze pad can not control the hemorrhage of the liver wound, suggesting that the hepatic vein trunk or the posterior inferior vena cava tear. Then we should take appropriate measures. Preoperative preparation 1. The greatest risk of liver injury is hemorrhagic shock. Especially when hepatic resection is required for severe trauma of liver tissue, the amount of hemorrhage is large and accompanied by different degrees of shock. Anti-shock and resuscitation treatment should be actively carried out, including blood preparation. Blood transfusion, infusion, oxygen supply, correction of electrolyte and acid-base balance disorders, protection of kidney function, prevention of renal failure and so on. At the same time, prepare for emergency surgery to ensure adequate blood supply, improve and maintain blood pressure, such as blood transfusion 500 ~ 1000ml in a short period of time, blood pressure is still not good, that is, should be anti-shock, while performing rescue surgery, should not wait. 2, most patients with hepatic vein injury after hemorrhagic shock, refractory hypotension or other organ damage, often dying before admission. Therefore, the first steps of preoperative treatment are active fluid resuscitation, blood transfusion, and infusion. The injured person quickly enters lactated Ringer's solution through the central vein or large limb vein within 15 minutes after admission; the infusion channel is mostly 2 or 3, and the upper extremity vein is selected. It is advisable to avoid loss of fluid input due to damage to the inferior vena cava and hepatic vein root. If the patient's blood pressure is still low, it indicates that there is a large amount of active bleeding. The patient should be stopped as soon as possible after the preoperative preparation, and the recovery should be continued as soon as possible to shorten the shock time. More than 90% of patients with shock for more than half an hour died, and a large number of cases reported a positive correlation between mortality and shock time. 3, deep shock, short-term blood transfusion can not rise after the blood transfusion, you can open the chest in the fifth intercostal space on the left, temporarily block the aortic blood flow on the sputum, so that blood pressure rises, maintain the blood supply to the heart and brain, until the open Healing at the injury site. 4. Serious combined injuries that are life-threatening should be dealt with first. If there is tension pneumothorax, measures such as chest drainage should be performed immediately to avoid serious breathing difficulties, hypoxia, cyanosis and shock, and even death. 5, those with difficulty breathing, should be well in early tracheal intubation to maintain good ventilation and oxygen. 6, preventive application of antibiotics. A dose is given before surgery, and then one or several doses are added at a certain interval according to the operation time and the half-life of the drug. 7, open injury, the wound should be wrapped with sterile dressing, a large number of bleeding when pressure bandage, immediate surgery. 8, put the stomach tube and catheter before surgery. Surgical procedure 1. Suture repair at the injury site It is a simple and effective method for the treatment of near hepatic vein injury. Intraoperative hemorrhage occurs immediately if hepatic hemostasis is ineffective or the liver is pulled up and down. This suggests a near-hepatic vein injury. At this point, the liver is first filled with hemostasis, but the large bleeding is not effective. It is only for the auxiliary hemostasis before the other operations. Immediately use the chest and abdomen combined incision, cut the diaphragm to the inferior vena cava, fully reveal the second hepatic hilar and hepatic naked area, control the large vessel cleft under direct vision, clamp the vena cava tear with the heart ear clamp, suture the cleft, accompanied by liver If the leaf is severely contused, the corresponding liver lobe can be removed. Finger pressure can also be used to control vascular ruptures and repair. In recent years, the right inferior costal incision was used, and the acupressure was used to control the vascular cleft and repaired successfully. 2, perihepatic vascular isolation and vena cava shunt For patients with direct repair failure, perivascular vascular isolation (full hepatic vascular exclusion) and vena cava shunt should be used. Whole hepatic blood flow block is to block 4 parts of blood at room temperature, first block the infraorbital abdominal aorta, then use the block to control the liver pedicle, then block the inferior vena cava at the level of the renal vein, and finally cut Happy bag, block the superior and inferior vena cava, the blocking time is 30min, no adverse consequences. There are three ways to bypass the vena cava blood flow through the vena cava: 1 Through the right atrium cannula to the inferior vena cava, use a 32 or 34Fr silicone tube to connect the diverting pump, ligation of the inferior vena cava in the pericardial cavity and the inferior vena cava above the renal vein. After the hepatic hilum is controlled, the vein injury is repaired. 2 through the inferior vena cava intubation, and then repair the vena cava damage. 3 Intubation at the junction of the femoral and saphenous veins: a polyethylene shunt tube (28Fr) with a length of about 66cm, a latex balloon 9cm at the top, inserted from the junction of the femoral and saphenous veins, and the bladder can be filled with water to the liver. The vena cava segment of the lower margin is completely obstructed, and the lateral hole on the catheter facilitates blood shunting. After the shunt is completed, repair the damage.