Repair of inferior vena cava injury above renal vein level

Inferior vena cava injury repair above the renal vein plane for surgical treatment of inferior vena cava injury. The injury of the superior inferior vena cava, especially the posterior segment of the liver, is one of the most difficult to treat and has the highest mortality rate due to the concealment and difficulty of the site. The wounded often combine with severe shock and liver and other organ damage. Treatment of diseases: pediatric inferior vena cava obstruction syndrome Indication Inferior vena cava injury repair above the renal vein plane is suitable for inferior vena cava damage above the plane of the gastric vein. Preoperative preparation At the same time of strong resuscitation, the chest and abdomen are prepared from the skin to the sternal notch, down to the middle of the thigh; systemic application of antibiotics to prevent infection; preparation of blood and preparation of their own blood transfusion device. Surgical procedure 1. A midline incision in the abdomen and a transverse incision to the right if necessary. There is a need to delay the opening of the sternum into the pericardial cavity, or turn to the upper right along the sixth intercostal space into the chest. 2. The inferior vena cava can be opened by incision of the mesenteric root and the ascending colon outside the peritoneum and Kocher operation, and the ascending colon and the hepatic flexion, duodenum, and pancreatic head are turned up to the left for exposure. The posterior inferior vena cava is most difficult to expose. It is necessary to cut the right hepatic triangle ligament and coronary ligament, and turn the right liver to the left to reach it. 3. Inferior vena cava injury of the lower part of the liver, suture can be done on the side wall, the method is the same as that of the inferior vena cava. There are 4 options for treatment of the inferior vena cava injury in the posterior segment of the liver. 1 suture liver laceration to stop bleeding. This segment of venous injury is often a continuation of interhepatic laceration, and the venous pressure is not high. You can try to squeeze the gap between the left and right livers from the two sides to the center. If you can stop the bleeding, use a large needle thread to suture the liver cleft (if necessary, add a pedicle membrane to fill). 2 simple block blood flow repair. Block the first hepatic hilum (including the proper hepatic artery, portal vein and bile duct), and use the assistant to manually press the infraorbital (or supraorbital) and inferior inferior vena cava to the posterior inner spine to block the blood flow, and then pass the liver. The rupture of the vein was found in the laceration, and the vascular fistula was used to lift the edge and suture directly. After the blood flow is restored, hemostasis is stopped and the liver laceration is sutured. 3 repair blood flow after blocking. If the upper method is used to stop bleeding, the venous rupture must be directly exposed for suture repair. In order to effectively control the fatal bleeding of the exposure process, the blood flow must be temporarily blocked. The method is to sequentially clamp or compress the aorta, the first hepatic hilum, and block the liver (in the pericardial cavity) and the inferior vena cava with a tourniquet. After controlling the bleeding, the right half of the liver was quickly released, and it was turned to the left to reveal the inferior vena cava of the posterior segment of the liver. Sometimes it is difficult to flip and reveal that some or even the entire right liver has to be removed. After the slit was clamped with a Satinsky forceps, the above-mentioned blockage was removed, and the slit was continuously sutured from top to bottom and from bottom to top with a 6-0 non-absorbent line. If the Satinsky forceps cannot be applied, the side wall will be repaired without blood. Those with a hepatic vein root tear are repaired together. After suturing the bleeding point on the hepatic wound in front of the inferior vena cava, the right hepatic liver was repositioned. 4 After the temporary diversion is established, it is repaired. Use a catheter with or without a balloon (such as an endotracheal tube, a crude Foley tube, or a chest drainage tube) for temporary shunting. Cut the bag and insert the catheter through the right atrial appendage (before the tip and the indwelling right atrium) Make a side hole in advance) below the renal vein opening. Use a tourniquet to tighten the inferior vena cava of the pericardium and the inferior vena cava above the plane of the renal vein to the catheter while blocking the hilum. Or incision of the inferior vena cava from the plane below the plane of the renal vein, inserting the Foley catheter upward into the right atrium, so that the balloon is located in the superior vena cava of the superior iliac crest, filling the water to block, and tightening the lower inferior vena cava to the catheter, while blocking Broken liver. It is also possible to insert a double-chambered catheter with a sausage-like sac from the right atrial appendage, and intra-intracapsular water injection to control bleeding, which can eliminate the operation of blocking the inferior vena cava. After the bleeding was controlled, the upper suture was used for repair. This method is theoretically reasonable, but the effect is not ideal. Because the trauma is too large, most patients die on the operating table.

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