Design And Employment Of Assistant Device For Rapid Total Hepatic Vascular Exclusion

Injuries to the root of hepatic vein and juxtahepatic vena cava are the severest cases in liver trauma with high mortality. The major obstacles for the management of these lesions are exposure and hemostasis, which lets surgeons fall into a vicious cycle of "exposure-bleeding-abandon". To conquer this problem, even liver transplantation and autotransplantation were used. Clear exposure of the injury and quick hemostasis are paramount for the treatment of these types of injuries. The most traditional management methods are complex, time-consuming, and severely traumatic for patients, although they may control the bleeding. Therefore, treatment of such injuries is still a challenge faced by surgeons.Shunt was invented by surgeons much earlier, which set a tube in the retrohepatic vena cava. Blood was blocked above and below the injury. It seemed reasonable and some success was reported, but more failures were reported later. In the reports, trachea cannula and chest cavity drainage tube were used. And no unified standard of the diameter was made. In my opinion, difficulties in controlling, open of chest and abdominal cavities, insufficiency of the shunt diameter and low efficiency in hemostasis are the reasons for failure. Some modifications were made by surgeons, but the success was seen only in some case reports. It was not accepted publically.By the development of vascular interventional technology, stent grafts were used, which was another kind of shunt. But the patients’ vital signs must be relatively stable, allowing enough time for surgeons to prepare. And at the same time, the position of the stent graft couldn’t been adjusted once it is released.In clinical practices, the patients with liver and juxtahepatic vena cava injuries are usually in shock or nearly in shock, who need emergency laparotomy. The combination of traditional surgery and vascular interventional technology leads to "temporary stent graft", which can repair the injury of the juxtahepatic vena cava from inside, and can achieve quick total hepatic vascular exclusion (THVE). We call it "assistant device for rapid THVE", which includes stent graft and delivering device.The measurement of actual volume and fluid dynamic analysis of juxtahepatic vena cava are the basic researches for the development of this device. And the actual effect of the device was detected.