RU2110224C1 - Method to transfer trachea - Google Patents

Abstract

FIELD: medicine, transplantology. SUBSTANCE: method deals with removing a recipient's trachea together with thyroid gland and the upper and the lower thyroid arteries taken together with area from corresponding supplying vessels of a donor followed by connecting donor's trachea and thyroid gland to hemodynamical favorable vascular formations. EFFECT: higher efficiency of transplantation.

Description

 The invention relates to medicine, namely to transplantation.

 There is a known method of tracheal transplantation, in which the donor trachea is removed after crossing in the distal and proximal sections, the recipient trachea is removed in the same way and the donor trachea is transplanted to the recipient, stitching the crossed ends of the trachea end-to-end.

 The disadvantages of the prototype include the lack of anastomoses between the vessels feeding the trachea. In addition, the lack of adequate blood supply to the trachea can cause graft necrosis.

 The aim of the invention is to increase reliability by creating anastomoses of vessels feeding the transplant.

 This goal is achieved by the fact that the trachea is taken from the recipient along with the thyroid gland and the upper and lower thyroid arteries and trunks of the bronchial arteries taken from the site of the corresponding supply vessels, and the donor trachea and thyroid gland are connected to hemodynamically beneficial vascular formations.

 Comparison of the proposed method with the prototype shows that in the proposed method there is a new action - the fence along with the trachea of the vessels supplying it with the subsequent connection of the donor trachea and thyroid gland to hemodynamically beneficial vascular formations. This improves the reliability of end-to-end tracheal anastomoses.

 The method is as follows. The donor trachea with the thyroid gland is taken from the complex according to Shore according to the general rules with the trachea crossing at the larynx and at the place of discharge of the main bronchi. Together with the donor trachea, the prepared upper and lower thyroid arteries with sites, the trunks of the bronchial arteries with sites are taken. The lateral vascular pedicle of the trachea - the collateral network of vessels on the sides of the trachea - is preserved during sampling. Then, the donor trachea is transplanted with the supply vessels to the site of the reciprocal tracheal portion of the recipient, which is proportionally removed. Stitch the end-to-end trachea. After this, the sites of the collected vessels (upper and lower thyroid, trunks of bronchial vessels) are sutured into hemodynamically advantageous large vessels (thyroid-cervical trunk, common carotid artery, aorta, etc.). In this case, a vascular clamp of the Satinsky type is superimposed on the vessel wall. The flow of arterial blood in these vessels is thus preserved. In this segment of a large vessel, a “window” section is cut from its wall above the clamp, with dimensions corresponding to the dimensions of the vascular site sewn in using the microsurgical technique of the vessel.

 The practical application of the method in the experiment is illustrated by the following examples.

 Example 1. The donor trachea and thyroid gland was extracted from the corpse of a 52-year-old patient (post-mortem diagnosis: acute cerebrovascular accident) with intersection at the level of the larynx and the site of discharge of the main bronchi with preservation of the lateral vascular pedicle of the trachea (diameter of the trachea 2.1 ± 0.1 cm ) The upper and lower thyroid arteries with sites and trunks of bronchial arteries with sites were taken with trachea.

 In the recipient, the trachea (diameter 2.0 ± 0.15 cm) was taken by access along the anterior surface of the neck and median sternotomy.

 The donor trachea is proportionally sewn end-to-end to the recipient. A curved vascular clamp is applied to the front-side surface of the recipient's common carotid artery. In this case, the blood flow is preserved in the place of application of the clamp by 1/3 of the diameter. From the portion of the recipient’s common carotid artery above the clamp, vascular scissors were cut into “windows” the size of the areas of the upper and lower thyroid arteries. Corresponding vessels with platforms are sewn into the “windows”. This operation was performed with the right vessels and with the left (thyroid and common carotid). A Satinsky clamp is applied to the aortic arch. The blood flow along the aortic arch is preserved at 1/2 of its diameter. Above Satinsky’s clip, a “window” is cut into which a platform of trunks of bronchial arteries is sewn.

 The reliability of superimposed anastomoses with the aorta and common carotid arteries was tested in the experimental model of blood flow by perfusion under pressure of the aortic arch and the vessels of the recipient departing from it. Leaking fluid (a solution of barium sulfate in water) was not observed at the sites of application of vascular anastomoses. The tightness of the end-to-end tracheal anastomosis was checked after intubation and injection of air into the upper airways by the Bobrov apparatus with preliminary filling of the wound with water. There were no air bubbles at the sites of anastomoses.

 Example 2. The donor trachea and thyroid gland was extracted from a corpse of a 63-year-old patient (post-mortem diagnosis: acute myocardial infarction) with intersection at the level of the larynx and the site of discharge of the main bronchi with preservation of the lateral vascular pedicle of the trachea tracheal diameter (19.0 ± 0.15 cm) . The upper and lower thyroid arteries were taken with the trachea (on both sides).

 In the recipient, the trachea (diameter 20.0 ± 0.1 cm) was taken by access along the anterior surface of the neck and median sternotomy.

 The donor trachea is proportionally sewn end-to-end to the recipient. A curved vascular clamp is applied to the front-side surface of the recipient's common carotid artery. In this case, the blood flow is preserved in the place of application of the clamp by 1/3 of the diameter. From the portion of the common carotid artery above the clamp, "windows" were cut out proportionally by vascular scissors under the sites of the upper and lower thyroid arteries, which are then sewn accordingly.

 The reliability of superimposed anastomoses with common carotid arteries and the tightness of the end-to-end tracheal anastomosis were confirmed in the corresponding experiment.

 This method was simulated in an experiment on corpses in another 8 studies. The goal of the method was achieved, as in the examples. In some cases, the vascular anastomosis is not superimposed in 6 places (the right and left lower and upper thyroid arteries - 4 anastomoses and 2 areas of the trunks of bronchial arteries), but in 5.4 - depending on the technical complexity of the fence and transplant, as well as the type of bronchial discharge arteries and their branches.

The presented method for tracheal transplantation offers:
in contrast to the prototype, to increase the reliability of the formation of the end-to-end tracheal anastomosis by maintaining adequate blood supply to the transplanted trachea;
to maintain the viability of the trachea as a whole by maintaining the nutrition of the lateral vascular pedicle of the trachea in the early postoperative period.

Claims (1)

 A method for tracheal transplantation, including taking a donor trachea while preserving the lateral tracheal leg, removing the recipient trachea, restoring the anatomical integrity of the tracheal walls by stitching end to end, characterized in that the donor trachea is taken together with the thyroid gland and the upper and lower thyroid arteries and trunks of the bronchial arteries taken from the site of the corresponding supply vessels, the donor trachea and thyroid gland are connected to the hemodynamically beneficial vascular formations of the recipient.