| Refractory ascites is a late symptom in patients with cirrhosis,once diagnosed,the prognosis is poor.Large number liquid discharge method(including repeated therapeutic abdominal puncture and abdominal drainage),among current methods to treat refractory ascites,has its problems,primarily including abdominal infection,massive protein loss,electrolyte disturbances.This method for ascites drainage way can avoid the above problems,because the drainage way is in the body,which enables ascites to drain into the systemic circulation directly.Peritoneal venous shunt is also internal drainage of ascites,but the surgery is complexed,the path length is very long,the abdominal and abdominal need multiple incisions and it generally requires general anesthesia,meanwhile there are the presence of drainage tube obstruction,subcutaneous and surgical incision leakage and other complications.This method only needs local anesthesia,puncture of the abdominal cavity through the hepatic vein,and the drainage channel channel is short and has no adominal incision.TIPS is not suitable for patients with high risk hepatic encephalopathy or increased clinical blood ammonia,because TIPS divert the portal vein blood flow to the systemic circulation,which can cause hepatic encephalopathy.The method drains ascites to the systemic circulation directly,it does not shunt the portal vein,nor increase hepatic encephalopathy risk.Transjugular-hepatic vein-peritoneal shunt is a new type method of interventional surgery in the treatment of ascites which we have been studying.This study can effectively avoid the existing various complications in the treatment of refractory ascites,providing the treatment of refractory ascites a minimally invasive,safe and effective treatment.Objective:1.To create a one-way valve stent suitable for TVS and try to split the valve replacement.2.Observe changes of vital signs and incidence of complications TVS intraoperative and postoperative.Investigate the safety and feasibility and the degree of liver injury and liver effects of TVS.3.By comparing change of the red blood cell count in blood samples and abdominal circumference variation of the experimental group with control group before and after operation,we investigate therapeutic efficacy of TVS.4.Through the anatomical observation of stent placement within the liver,we tend to explore the stents with liver tissue compatibility and effects on liver function.Methods:20 experimental swine about 20kg±2kg,male and female combination,randomly assigned 10 into control group,10 into experimental group.Record the waist circumference of every pig preoperatively,and then puncture abdominal by sheath and inject 2000 ml saline to made the waist circumference record postoperative ascites model at oh,24 h,48h,72 h,and observe the status of general life.Record waist circumference of experimental group preoperatively and after modeling,carries out TVS,drew blood from the hepatic vein and vena cava respectively as a specimen before and after TVS,compare the ratio of red blood cell count before and after operation,and record waist circumference at 24 h,48h,72 h and observe the status of general life.Fed the pigs proper amount every morning and night next three days,and injected heparin subcutaneous 1000 units.Compared the previous waist circumference and the red blood cell count change with the waist circumference after stent placement of two groups,observed the effect of ascites drainage.Postoperatively anatomy and observed stents placed in the liver,and took part of the liver tissue to observe pathological change of liver tissue.Results: 1.The experimental group 10 ascites model of stent implantation were all placed well,the success rate of stenting is 100%,and one case were valve replacement,process effect is good,operation is simple and feasible.2.After one-way stents Unicom peritoneal and hepatic vein postoperative,pigs have a good tolerance and stable vital signs,detected by PICCO after modeling,right heart load will increased a little but in affordable range,pigs all woke up half to one hour.3.The postoperative 1 day can eat right amount,2 days,ascites is reduced rapidly,urine increased and weight reduced,activities and status come to normal.4.Blood tests showed blood cell count in the vein of stent shunt intrahepatic was significantly lower than vena blood cell count,hemodilution and drainage were confirmed well.Preoperative and postoperative liver function had no significant difference,we concluded that this experiment for liver function has little impact.5.Postoperative 24 h,48h,72 h the waist circumference reduce less than the control group obviously,confirmed that the effect of fission one-way flapper stent drainage ascites to reduce waist circumference is obvious.6.Postoperative anatomical liver tissue pathology: lobular liver cells swelling degenerated,partial liver blood sinus expanded and blood happened.Liver cells swelling degenerated,portal area is normal.Partial around the central vein of liver hepatic sinus expanded blood stasis,part of liver cells acidophilic degenerated.Conclusions:1.2000 ml saline water mixed with 10 ml vein blood intraperitoneal injection made simple ascites model,similar to ascites in patients with refractory ascites,which provide proper model for the basic research of liver cirrhosis ascites stenting.2.The fission stent placement process is simple,convenient,stent location accurate,valve can be changed smoothly.3.Reduce speed of the waist circumference is significant compared with control group,ascites can be exactly drained by the drainage channel.Small surgical trauma,important organ damage,liver failure or death complications didn't show up.4.TVS had no obvious effect on the right heart function.5.TVS had no obvious effect on liver function.6.Preliminary results showed that fission one-way flapper stents and liver tissue has good histocompatibility,static closed one-way valves can prevent the outflow of blood surely.7.Omentum package is the main complications,no life-threatening complications.8.Simple surgical procedures and minimally invasive,the success rate is 100%. |
PDF Full Text Request