RU2506906C2 - Method of extracting adrenal glands with preservation of vascular pedicles - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be applied for extraction of adrenal glands. Complex of thoracic cavity organs is ablated. Organs, located below pancreas are ablated. Liver, spleen and stomach are ablated. Mobilisation of lateral parts of diaphragm to external edges of kidneys is performed. Diaphragm is separated from vertenral column. Adrenal glands, kidneys and cellular tissue of reproperitoneal space are separated from parietal fascia of abdomen. Arterial parts of vascular pedicle of left and/or right adrenal gland are exposed. Venous parts of vascular pedicle of left and/or right adrenal gland are exposed. Aortal component of vascular pedicle of left and/or right adrenal gland is formed. Venous component of vascular pedicle of left and/or right adrenal gland is formed.

EFFECT: method makes it possible to accelerate exposure of adrenal gland, to preserve its vessels.

3 dwg

Description

Method for extracting adrenal glands while maintaining vascular legs

The invention relates to medicine and can be used in pathological and anatomical practice and transplantology in the preparation of a human adrenal transplant.

Currently, organ harvesting from a corpse has been accepted for according to the method of A. Abrikosov (Abrikosov A.I. Technique of postmortem autopsy. M., 1925, M - L., 1939, M., 1948 and the method of Shor G.V. (Shor G.V. To the technique of pathoanatomical research of human corpses. Tr. meeting Petrograd, and the Moscow Society of Pathologists. M. - Pg. - 1923. pp. 81-88; Shor G.V. On the death of a person - L. Kubuch., 1925).

The method of sequential organ evisceration according to the method of A. Abrikosov consists in the removal of organs separately according to the systems:

1) extraction of the respiratory system (organs of the neck and chest cavity)

2) intestinal extraction

3) spleen extraction

4) extraction of the liver, stomach, 12 duodenum, pancreas

5) extraction of the kidneys, adrenal glands, ureters, pelvic organs together with the abdominal aorta and inferior vena cava.

In this case, the extraction of the kidneys and adrenal glands begins with a semicircular incision of the retroperitoneal klepka parallel to the outer edge of the left kidney and the adrenal gland. Grabbing the kidney with the adrenal gland with your left hand and lifting it anteriorly from the midline, separate with a knife with surrounding tissue right up to the spine. Then allocate the left ureter before entering the small pelvis. Similar procedures are carried out on the right. Subsequently, the abdominal aorta with the inferior vena cava is captured with the left hand in the upper section and the spine is separated from top to bottom. Separating from the walls the internal organs of the pelvis, hide the inguinal canals, testicles, bladder.

The method of complete evisceration of organs according to Shore G.V. (1923) consists in extracting the entire organocomplex of internal organs in a single block, starting from the organs of the neck and ending with the organs of the small pelvis, with their separation from the walls of the neck, chest cavity, abdominal cavity and pelvis.

The disadvantages of the described analogues include the following:

1) the blood vessels of the adrenal glands are disturbed, which does not allow the use of these complexes for transplantation;

2) it is difficult to isolate the adrenal gland and its vascular legs for preparing a donor transplant from a whole organ complex according to Shore or from a system unit according to Abrikosov.

The technical result consists in the fact that the claimed method allows to obtain a complex of organs, consisting of adrenal glands and the main sources of its nutrition and venous outflow, which allows the use of this complex in the form of a donor transplant.

A method is disclosed for removing the adrenal glands, including removing the complex of the organs of the chest cavity, removing the liver, spleen and stomach, mobilizing the diaphragm, characterized in that the adrenal glands, kidneys and fiber of the retroperitoneal space are separated from the parietal fascia of the abdomen, the venous sections of the vascular leg of the left and / or right adrenal gland are isolated form the aortic component of the vascular pedicle of the left and / or right adrenal gland; form the venous component of the vascular pedicle of the left and / or right adrenal gland.

Figure 1 shows the complex of the left adrenal gland with vascular legs, where:

1 - abdominal aorta;

2 - the inferior vena cava;

3 - renal artery;

4 - upper adrenal artery;

5 - middle adrenal artery;

6 - lower adrenal artery;

7 - the central vein of the adrenal gland;

8 - the left renal vein.

Figure 2 shows the complex of both adrenal glands with vascular legs, where:

1 - abdominal aorta;

2 - the inferior vena cava;

3 - renal artery;

4 - upper adrenal artery;

5 - middle adrenal artery;

6 - lower adrenal artery;

7 - the central vein of the adrenal gland;

8 - the left renal vein.

Figure 3 shows the complex of the right adrenal gland with vascular legs, where:

1 - abdominal aorta;

2 - the inferior vena cava;

3 - renal artery;

4 - upper adrenal artery;

5 - middle adrenal artery;

6 - lower adrenal artery;

7 - the central vein of the adrenal gland.

The method is implemented as follows, for example, in the case of the left adrenal gland. For this:

Stage 1 - removal of the complex organs of the chest cavity - both lungs and mediastinal organs;

Stage 2 - removal of organs located below the pancreas, along the lower edge of the kidneys;

Stage 3 - removal of the liver;

Stage 4 - removal of the spleen and stomach;

Stage 5 - mobilization of the lateral parts of the diaphragm to the outer edges of the kidneys;

Stage 6 - separation of the diaphragm from the posterior edge of the spinal column;

Stage 7 - separation of the adrenal glands, kidneys and fiber of the retroperitoneal space from the parietal fascia of the abdomen;

8 stage - the allocation of the arterial divisions of the vascular pedicle of the left adrenal gland by preparation from the posterior surface of the aorta;

Stage 9 - the allocation of the venous sections of the vascular pedicle of the left adrenal gland by preparation from the front surface;

Stage 10 - the formation of the aortic component of the vascular pedicle of the left adrenal gland;

Stage 11 - the formation of the venous component of the vascular pedicle of the left adrenal gland.

As a result, we obtain a complex of the left adrenal gland with vascular legs, which contains the left adrenal gland, the vascular legs of which include the left adrenal arteries with a section of the abdominal aorta of the origin of these arteries and the left adrenal veins with a section of them flowing into the inferior vena cava or left renal vein.

Similarly, a complex of the right adrenal gland with a vascular pedicle and a complex of both adrenal glands with a vascular pedicle are obtained.

Thus, the method allows to obtain a complex of organs, consisting of the adrenal gland and the main sources of its nutrition and venous outflow, which allows the use of this complex in the form of a donor transplant.

Claims (1)

A method for extracting the adrenal gland while preserving the vascular legs, which consists in removing the complex of organs of the chest cavity, removing organs located below the pancreas, on the lower edge of the kidneys, removing the liver, spleen and stomach, mobilizing the lateral parts of the diaphragm to the outer edges of the kidneys, the diaphragm from the spinal column, the adrenal glands, kidneys and fiber of the retroperitoneal space are separated from the parietal fascia of the abdomen, the arterial sections of the vascular pedicle of the left and / or right adrenal gland are isolated Is isolated venous pedicle sections of the left and / or right adrenal, aortic component form of the pedicle of the left and / or right adrenal formed component venous pedicle left and / or right adrenal gland.

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