cavity-atrial bypass

Cavity-atrial bypass is used for the surgical treatment of Budd-Chiari syndrome. Budd-Chiari syndrome refers to hepatic venous hypertension, central venous and hepatic sinus dilatation, blood stasis or inferior vena cava blood stasis caused by obstruction of the hepatic vein outflow tract or inferior vena cava reflow. Clinical manifestations of portal hypertension such as hepatosplenomegaly Large, esophageal varices bleeding, ascites, hypersplenism, etc., can also be expressed as trunk and lower extremity varicose veins, lower extremity swelling, pigmentation and long-term ulcers. According to the vascular obstruction site, Budd-Chiari syndrome can be divided into inferior vena cava membranous and segmental obstruction, hepatic vein opening or distal extensive obstruction and hepatic vein inferior vena cava mixed obstruction. Due to the complicated classification and more surgical methods, there is no single method for treating Budd-Chiari syndrome of different pathological types. The treatment should be selected according to the pathological type. In recent years, the development of interventional radiotherapy has improved the treatment of Budd-Chiari syndrome. The interventional or interventional surgery has significantly improved the clinical efficacy of Budd-Chiari syndrome. Right atrial and inferior vena cava bypass is the main method for the treatment of membranous or segmental obstructive Budd-Chiari syndrome of the inferior vena cava, although the application of new artificial blood vessels and the improvement of anastomosis technology improve the clinical efficacy of the operation. Currently, the operation is mainly used for interventional failure. Treatment of diseases: pediatric inferior vena cava obstruction syndrome Indication Cavity-to-housing is suitable for: 1. Inferior vena cava localized obstruction or stenosis, and the hepatic vein to the inferior vena cava is unobstructed or has a large accessory hepatic vein. 2. Inferior vena cava rupture or resection of the resection of the membrane. Contraindications 1. Wide stenosis and obstruction of the inferior vena cava 2. Complete hepatic vein occlusion or secondary cirrhosis. 3. The patient's general condition is difficult to tolerate surgery. Preoperative preparation In addition to routine examination, color Doppler and MRI angiography or electron beam CT angiography were performed preoperatively to understand the location and extent of vascular occlusion. Surgical procedure 1. Firstly, the mid-abdominal incision or right rectus abdominis incision is performed to explore the abdominal cavity, the size of the liver and spleen is detected, the ascites is aspirated, the portal vein pressure is measured, and the liver tissue is taken for pathological examination. 2. Lift the transverse colon, in the third segment of the duodenum, open the peritoneum, or sharply separate the colonic hepatic curvature and the ascending colon side peritoneum, push the ascending colon and ureter to the left, revealing the inferior vena cava up to 4 ~ 6cm, Ligation of the lumbar vein if necessary. 3. Chest surgery: For patients with moderate ascites, the anterior sternal incision should be used. For no or a small amount of ascites, the right fourth intercostal thoracic incision can be used to cut the intercostal muscles into the chest and fully stop bleeding. Push open the right lung, cut the pericardium in front of the right phrenic nerve, expose the inferior vena cava, right atrial appendage and right atrium, and do pericardial traction. 4. Cut the diameter of about 2cm in the forefront of the right iliac crest for the passage of artificial blood vessels, and take the PTFE or polyester artificial blood vessel with the outer support ring of 16mm in diameter and 30cm in length, and trim one end into a trumpet or a snake head shape. The anterior wall of the vena cava was broken, and the vessel wall was incised in an oval shape. The artificial blood vessel was anastomosed to the end of the inferior vena cava with a 5-0 non-invasive suture. The anastomosis should be naturally dilated by the external support ring. 5. The other end of the artificial blood vessel passes through the colon, the stomach and the liver, poke the hole through the diaphragm to the right thoracic cavity and mediastinum, trim the other end of the artificial blood vessel, block the right atrial wall length of 3cm, and use the continuous eversion continuous suture method. The blood vessel is anastomosed to the right atrial side. After the anastomosis is completed, a needle is inserted into the thoracic cavity to discharge the air in the artificial blood vessel, and the inferior vena cava and right atrial occlusion forceps are released, the venting needle is removed after the blood vessel is filled, and the blood leakage point is slightly clamped by the mosquito forceps. Can stop bleeding. 6. Repeat the portal vein pressure measurement, partially suture the pericardium, and place the thoracic and abdominal incision layer by layer after the chest or mediastinal drainage tube. 7. Posterior ventricular transfusion was performed with standard right thoracic incision. From the 6th or 7th ribbed bed into the abdominal cavity, push the right lung, cut off and ligature the lower ligament, free the right phrenic nerve and pull back, right The position of the nerve is cut into the happy bag, the diaphragm is cut along the inferior vena cava, and the inferior vena cava is displayed in the bare area of the liver to the normal place. According to the above method, the artificial blood vessel of the PTFE artificial blood vessel with the outer support ring of 16 mm diameter is successively The inferior vena cava and the right atrial end-to-side anastomosis were used to exclude the air in the tube. The inferior vena cava and right atrial occlusion forceps were released, and the chest drainage tube was placed to close the chest layer by layer. complication Thrombosis The development of artificial vascular materials significantly improves the patency rate of blood vessels. Anastomotic techniques and vascular distortion are the main factors leading to thrombosis. Proficiency of anastomosis techniques, good vascular materials and proper selection of vessel length and caliber are key to preventing thrombosis and improving patency. . 2. Hemorrhagic shock The main reasons: 1 right atrial suture is not strict; 2 intrathoracic branch branch branch ligation is not complete; 3 inferior vena cava rupture; 4 coagulation dysfunction. Prevention: The right atrial suture should be tight after the rupture of the membrane, and the inferior vena cava and its branches should be carefully sutured and ligated to actively improve the general condition and coagulation function. 3. Pulmonary embolism Free thrombus detachment under the diaphragm after rupture of the membrane leads to acute pulmonary embolism after surgery. Prevention: After the membrane is broken, carefully explore the presence or absence of free thrombus under the diaphragm. Once it is found, it should be completely removed during the operation. Postoperative routine anticoagulation to prevent thrombosis.