Portal and vena cava side-to-side shunts

Portal vein and vena cava lateral-lateral shunt for surgical treatment of portal hypertension. The portal vein and vena cava side-to-side shunt is an anastomosis of the portal vein and the inferior vena cava. The size of the anastomosis determines the antihypertensive effect of the shunt and the hepatic blood flow to the portal vein. Usually more than 1 ~ 1.2cm. In order to prevent the expansion of the anastomosis after surgery, some people advocate attaching an anastomotic ring to the anastomosis. Treatment of diseases: portal hypertension Indication 1. Intrahepatic obstructive portal hypertension complicated with esophageal and gastric varices bleeding. 2. Rebleeding after splenectomy or spleen and kidney shunt. 3. Hepatic vein distal obstruction type cloth-plus syndrome. Preoperative preparation 1. Give high sugar, high protein, high vitamin, low salt and low fat diet. For patients with poor appetite, appropriate parenteral and enteral nutrition support should be given, such as intravenous supplementation of GIK fluid and branched-chain amino acids to enhance nutrition and improve general condition. 2. Patients with major bleeding, if there is moderate anemia and obvious hypoproteinemia, an appropriate amount of fresh whole blood and human albumin or plasma should be intermittently infused 1 week before surgery. 3. Liver treatment: In addition to the use of general liver protection drugs, if necessary, hepatocyte growth factor, hepatocyte regenerating hormone, glucagon and so on. 4. Improve the coagulation mechanism. One week before surgery, routine intramuscular or intravenous injection of vitamin K11. For patients with prolonged prothrombin time and significantly lower platelet count, conditional preoperative injection of platelet suspension, cryoprecipitate or freshly lyophilized plasma (precursor containing various clotting factors and Fibronectin). 5. Prophylactic antibiotics. One dose should be given 30 minutes before surgery, and 1 to 2 doses should be used for intraoperative use. Antibiotics should be selected from a broad spectrum of drugs, such as aminoglycosides, cephalosporins, and anti-anaerobic drugs such as metronidazole or tinidazole. 6. Digestive tract preparation: patients with esophageal transection should be treated with 0.1% neomycin gargle and oral administration before surgery to clean the mouth and esophagus. The enema should be cleaned before surgery. It can also be heated with 25-50 g of magnesium sulfate powder. Mix 1500ml of boiling water, clean the intestines to avoid enema. Place a fine and soft nasogastric tube 30 minutes before surgery. Before placing the tube, take oral liquid paraffin 30ml to lubricate the esophagus. 7. In general, catheterization should be left before surgery. Surgical procedure 1. According to the end-to-side shunt of the portal, the portal vein and inferior vena cava are shown. See the endoluminal end-side shunt. 2. The posterolateral wall of the portal vein and the anterior wall of the inferior vena cava were selected as the lateral anastomotic sites. The portal vein and inferior vena cava sidewalls were blocked with atraumatic trilobal forceps. 3. Cut an elliptical hole in the blood vessel wall of the anastomosis site, the maximum length is 0.8-1.2 cm, and the suture method is anastomosed with the end-to-end end of the portal cavity (endo-vessel end-side shunt). 4. If the hepatic caudate lobe is too large or other causes the portal vein and the inferior vena cava are too large to be close to the anastomosis, a length of polyester or expanded artificial blood vessel can be used to end the end of the portal vein and the inferior vena cava. Portal vein H-shaped shunt. 5. In order to prevent the natural expansion of the shunt diameter, it is feasible to restrict the lateral side of the portal cavity, and the outer ring with the same inner diameter and the anastomosis. The restriction ring can be constructed from an angiographic catheter.