RU1819579C - Method for multiple intake of abdominal organs and organs in retroperitoneal area for transplanting - Google Patents

Abstract

The method of multiple abdominal organs and retroperitoneal space for transplantation to expand the accessibility zone and reduce the time of abdominal and retroperitoneal organs sampling, when at the same time with the deflecting abdominal aorta and the inferior vena cava, they begin to be perfused with a constant overpressure of 15- 20 mmHg under the control of a pressure gauge. The specified complex of organs is isolated in its entirety, placed on the preparation table with the back (retroperitoneal) surface upwards, and the corresponding vessels of all organs to be harvested are selected, cannulated and intersected. The method was experimentally tested (2 cases), which confirmed the achievement of these goals. ate

Description

This invention relates to medicine, namely to transplantology (organ transplantation).

The aim of the present invention is to expand the accessibility zone and reduce the time of abdominal and retroperitoneal organ harvesting.

The actual method is carried out as follows. A median incision from the xiphoid process of the sternum to the pubic joint covers the peritoneal cavity of the corpse (donor). At the level of the diaphragm, dissecting it from the anterior abdominal wall to the posterior peristral peritoneum, and at the level of the lower lumbar vertebrae, the peritoneum is isolated, dripped and traversed

aorta and inferior vena cava. Through the introduced cannulas, perfusion of the entire abdominal aorta and inferior vena cava with Ringer’s cold solution at an overpressure of 15–20 mm Hg, controlled by a manometer, immediately begins. If the pressure is less than 15 mmHg (excess), then peripheral branches and tributaries are not filled if more than 20 mmHg. This increases the likelihood of rupture of small vessels and capillaries. Then, the parietal peritoneum is dissected by bordering lateral sections along the outer edges of the ascending and descending intestines from the diaphragm to the pelvis, and the entire complex of abdominal and retroperitoneal organs is stupidly peeled off along with

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abdominal aorta and inferior vena cava of the daughter and brain) it was decided to fence

aperture level. Mobilize the abdominal and retroperitoneal gastric organs

with the intersection of the esophagus at the level of the car-space: liver, pancreatic jaundice, a liver with a portion of the diaphragm, kidneys with adrenal glands is secreted for the latter. The resulting organocomplex is removed from the 5th transplant to various recipients,

from the corpse, turn over and place on the Organocomplex removed from the abdominal pairwise drain of the back (retroperitoneal cavity of the corpse by the proposed method for

noy) surface up. In this case, the abdomen was 5.0 ± 0.5 min (with the already existing peritoneal aorta and inferior vena cava, there were fusions). The time for the complete isolation of the pancreatic surfaces of everything. Next, a secreted gland is carried out on a preparation table.

the division, cannulation, and intersection, respectively, amounted to 4.2 ± 0.1 min, kidneys from the adrenal venous inflows with arterial arteries - 3.3 ± 0.1 min, and liver - 3.0 ± 0.5 min.

. Branches of organs subject to collection. For comparison: in analogue and prototype

carrying out the indicated manipulations according to the average time of sampling of each of the organs in

the division of the organocomplex and the individual organs is approximately 20 gans; they perfuse them all the time for 40 minutes.

aorta and inferior vena cava with constant P r and m in p 3, From the corpse of the patient, 41 g.

overpressure under the control of a mano- (cause of death: o. cranio-cerebral trauma meter (as indicated above) through a preliminary) immediately after ascertaining the fact of biothelially guided cannula. 20 logical death fence

PRI me R 1. From the corpse of patient A., 44 liver, kidneys with adrenal glands, I turned yellow (cause of death: acute myocardial infarction) of the mammary gland in this way with pre-establishment after biological verification, cannulation and

death, it is proposed to perform perfusion by perfusion of the peritoneal aorta and

checks, kidneys with periosteum, pancreatic-inferior vena cava with constant excess gland for subsequent transplant pressure 11-13 mm Hg For Perf. Different patients. Access granted, si used refrigeration

Isolation, Qi cannula and perfusion of abdomen-saline, tinted

aortic aorta and inferior vena cava with post-methylene blue.

nn overpressure of 17 mm Hg 30After removing the organocomplex and

The entire organizational complex was located at its preparation table

as already indicated in the practical implementation, as indicated in the description of the practical

way of becoming. Separate small branches of the method, prepared

peritoneal aorta to the spine (5 pcs.) n isolated organ branches and tributaries I, P,

when highlighting, branching (merging) in the ovens intersected between the zagi-35 and iv orders is observed. The resulting organizational complex is extracted from the life, pancreas and kidneys. At

the abdominal cavity of the corpse, turned upside down and, therefore, all the time from the moment of cannulation was condemned to the cooking table, the retroperitoneum was continuously perfused with

face up. Naked, cannulated-indicated pressure. After exercise

baths and crossed vessels of the kidneys and preparations you dreamed that stained

the kidneys of the right and left, through this methylene blue physiological razorzvyzny canoli started local perfu-creature reached the organ branches of the abdominal aorzi of the kidneys and adrenal glands. Only the I and II branching orders are analogous,

branches of the celiac trunk of organ inflows of the inferior vena cava - 1st

and venous tributaries from the liver and pancreas, if not. Thus, the distal gland. After that, each of the departments of the branched arteries and veins,

the largest organs isolated from the surrounding capillary bed remained excluded

tissue and placed icy bathtub. Because of perfusion circulation, the investigator organocomplex was placed, the probability of development of the cell-retroperitoneal surface was high, and the kidneys with 50th necrobiosis, liver, kidneys,

adrenal gland and pancreas gland adrenal gland and pancreas with

are organs of retroperitoneal pro-impossibility to use these

wandering, all of them are easily viouralized by organ bodies for subsequent transplantation.

are achieved because not obscured by neighboring Example PRI me R 4. From the corpse of a patient N., 55

organs (primarily the intestines) and not 55l (cause of death, brain damage

covered with a parietal peritoneum, like blood circulation) after the fact is established

takes place in the analogue and prototype. biological death fence

Example 2. After the establishment of the liver, kidneys and adrenal glands, pancreatic biological death of patient D., 30 gland of the proposed method with

l (cause of death; consequences of car injury

preliminary isolation, cannulation and perfusion of the abdominal aorta and inferior vena cava at a constant overpressure of 21-22 mm Hg A cold physiological solution stained with methylene blue was used as a perfusate. For all subsequent manipulations, perfusion of the entire organocomplex was constantly carried out.

After removing the organocomplex and placing it with its rear surface up on the preparation table, it was prepared. organ branches and tributaries of the I, II, III, and IV orders of intrusion (fusion) in the pancreas, kidneys, and liver were distinguished. At the same time, it was seen that there are gaps in the region of small branches and tributaries (of the third and fourth orders), as well as of the capillary bed in the liver and kidneys. A similar situation led to a violation of the perfusion circuit in these organs, their anatomical and physiological integrity, swelling and unsuitability for use as a transplant.

Thus, the overpressure above the normal residual is less than 15 and more than 20 mm Hg. unacceptable since leads to unsuitability of the abdominal organs and retroperitoneal space for preservation and subsequent transplantation for the above reasons.

The effectiveness of the method.

The proposed method of multiple abdominal organs and the peritoneal space for transplantation allows:

- unlike the prototype and analogue, expand the accessibility zone during manipulations on preparing the organs to be harvested for transplantation, because the process of this preparation takes place on the preparation table, and not in the abdominal cavity of the donor;

- unlike the prototype and the analogue, reduce the processing time of the organs to be harvested, because manipulations to isolate, cannulate and cross the corresponding vessels are carried out in the immediate vicinity of the abdominal aorta and inferior vena cava, which are located most superficially with respect to the preparation;

Claims (1)

- unlike the prototype and the analogue, to ensure control by means of a constant pressure gauge in the perfusion system to prevent both insufficient filling of the peripheral arterial and venous bloodstream with a solution and the possibility of rupture of small and capillary vessels. SUMMARY OF THE INVENTION A method for multiple abdominal cavity and retroperitoneal organ sampling for transplantation by removal of the entire complex of these organs with the abdominal aorta and inferior vena cava, branches and tributaries, characterized in that, in order to expand the accessibility zone and reduce the sampling time, simultaneously cannulas of the abdominal aorta and inferior vena cava begin their lerfusion with an excessive constant pressure of 15–20 mm Hg. under the control of the pressure gauge, a complex of these organs is isolated in their entirety, placed on the preparation table with the retroperitoneal surface upwards, and the selection, cannulation and intersection of the corresponding vessels of all organs to be taken are performed.