Design Of A Kind Of Inferior Vena Cava Occlusion & Drainage Catheter And Investigation Of Its Effect On Haemodynamics During Liver Operation

Massive intraoperative hemorrhage was anticipated in liver operations. The basic method to reduce liver bleeding was to control the inflow and outflow vascular pedicles of the liver. Inflow vascular occlusion included hepatic pedicle clamping, hemihepatic and segmental vascular clamping, and selective inflow vascular occlusion; Outflow vascular clamping contained infrahepatic inferior vena cava (IVC) occlusion, suprahepatic IVC occlusion and control of major hepatic veins.Pringle's maneuver was a routine technique in liver resections. Total vascular exclusion (TVE) was required to reduce hemorrhage and avoid air-pulmonary embolism in the operation of huge tumor in right liver, tumor in caudate lobe, hepatic lesions closely adherent to or infiltrating the retrohepatic vena cava or centrally located in the liver strictly in contact with the hepatic vein convergence. TVE may induce severe hypotension, low cardiac output, and other impaired haemodynamics in some patients and led to perioperative morbidity and mortality.How can we control the liver blood flow quickly and expediently in liver operations to reduce bleeding, obtain a clear operative field, and maintain normal haemodynamics to ensure the sufficient perfusion of major organs simultaneously?A kind of inferior vena cava occlusion & drainage catheter (IVCODC) was designed to satisfy this demand. According to the design, IVCODC can be used to occlude the retohepatic vena cava to prevent the back flow of major and minor hepatic veins with double balloons, which may decrease the hemorrhage during hepatectomy, and can drain most of the blood in inferior vena cava to right atrium, which may maintain the hemodynamic stability simultaneously.An IVCODC was made according to the design and used in an in vivo sheep experiment. Many hemodynamic indices, such as IVC pressure, cardiac output, cardiac index, and so on, were detected to investigae the protective action of IVCODC on hemodynamic stability during liveroperations.Materials and Methods:1. Experimental animal: Four sheep with mixed gender were used. The weight was 41-47kg. The sheep did not eat solids two days before surgery and did not have fluids from the night before surgery. No premedication was used and the sheep was operated under general anesthesia with tracheal intubation.2. Grouping: Before-after study was used in this investigation. The hemodynamic changes were observed before and 10 min after Pringle's maneuver combined with infrahepatic IVC clamping in every sheep and were assigned to general preoperative group and general postoperative group, respectively. After releasing the clamping, an IVCODC was entered from right common iliac vein into the appropriate site of IVC. The hemodynamic changes of every sheep were recorded before and 10 min after Pringle's maneuver combined with infrahepatic IVC and suprahepatic IVC clamping by inflation of the balloons of IVCDOC and were assigned to IVCODC preoperative group and IVCODC postoperative group, respectively.3. Detection indices: Arterial blood pressure, IVC pressure, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), stroke index (SI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), left ventricular stroke work index (LVSWI), right ventricular stroke work index (RVSWI), left cardiac work index (LCWI), right cardiac work index (RCWI), and IVC pressure (IVCP), and renal perfusion were detected.4. Surgical procedure: The incision was from xiphoid to pubis conjunction. The hepatoduodenal ligament was dissected and encircled with a tape. The infrahepatic IVC was freed from the retroperitoneum and mobilized below the liver and encircled. Hemodynamic indices were measured before the clamping and assigned to the general preoperative group. Then, clamps were applied in the following order: ?hepatoduodenal ligament and ?infrahepatic IVC. All the hemodynamic indices...