Thomford N R, Papouras W C, Durzinsky D S
Department of Surgery, Medical College of Ohio, Toledo 43699-0008, USA.
Am Surg. 1998 Aug;64(8):791-4.
Injuries to the hepatic veins and retrohepatic vena cava have a high mortality due to uncontrolled hemorrhage. Successful repair may necessitate interruption of flow through the retrohepatic vena cava. Active bypass of the area is then needed to provide adequate venous return. Published methods for active bypass require cannulation of axillary and femoral veins in addition to clamping of the vena cava above and below the liver, often with limited exposure and significant risk. This report describes active bypass of the retrohepatic vena cava utilizing two right atrial cannulae. The simplicity of establishing the bypass together with the excellent exposure allowed repair of a bullet wound of the vena cava in one patient and the orderly performance of a left trisegmentectomy for a huge hepatic tumor in a second patient.
肝静脉和肝后下腔静脉损伤因出血难以控制而死亡率很高。成功修复可能需要阻断肝后下腔静脉的血流。然后需要对该区域进行主动转流以提供足够的静脉回流。已发表的主动转流方法除了要夹住肝脏上方和下方的腔静脉外，还需要对腋静脉和股静脉进行插管，且通常暴露有限、风险很大。本报告描述了利用两根右心房插管对肝后下腔静脉进行主动转流。建立转流的简便性以及良好的暴露效果使得一名患者的腔静脉枪伤得以修复，另一名患者得以顺利进行巨大肝肿瘤的左半肝三段切除术。
