SU1286165A1 - Method of transplanting small intestine - Google Patents

Abstract

This invention relates to medicine and may be used in surgery for transplantation of the small intestine. The aim of the invention is to improve engraftment by providing continuous graft perfusion of the recipient during the transplant steps. To do this, after mobilization of the small intestine and release of the vessels feeding it from the recipient and donor, removal of the spleen and small intestine from the recipient and release of the femoral artery and the splenic vein in it, shift the surgical stats and connect the recipient with the shunting of the femoral artery and splenic vein, respectively. colonic artery and eponymous vein of the donor. Clamp the mesenteric artery and donor vein proximal to the branch site on the vessels used for shunting, and at the same time turn on the blood flow in the shunts and provide blood supply to the donor's small intestine from the recipient's body. The transplant is removed from the donor, the operating tables are moved apart and the donor’s intestine is placed in place removed from the recipient. The vessels of the graft are connected to the vessels of the recipient. Temporary shunts are removed. 1 hp ff, 8 ill. (L

Description

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This invention relates to medicine and may be used in surgery for transplantation of the small intestine.

The aim of the invention is to improve engraftment by ensuring continuous perfusion of the small intestine with the recipient's blood during the transplantation stages, which is achieved by connecting temporary external shunts when taking the transplant of his femoral artery vessels and the splenic vein of the recipient, and after restoring the vascular connections of the transplant and receiving the injector, the recipient extracts.

FIG. 1 shows a mobilized fine sap with the vessels isolated from the donor and the recipient, a general view; in fig. 2 - removal of the small intestine and spleen in the recipient; in fig. 3 - the imposition of temporary external shunts; in fig. 4 - the inclusion of blood flow in temporary shunts; in fig. 5 - extraction of the small intestine from the body of the donor; in fig. 6 - the placement of the donor intestine at the place removed from the recipient; in fig. 7 - connection of the superior mesenteric arteries of the donor and the recipient; in fig. 8 - connection of the upper mesenteric. Donor and recipient.

In the figure, are received designations: 1 - small intestine recipient 2 - small intestine donor 3 - the superior mesenteric artery of the recipient, 4 - superior mesenteric Vienna recipient 5 - splenic Vienna recipient 6 - femoral artery of the recipient, 7 - the superior mesenteric artery of the donor , 8 - superior mesenteric vein of the donor, 9 - ileal-colic artery of the donor, 10 - iliac-colic vein of the donor.

The method is carried out as follows.

After mobilization of the small intestine and the release of its feeding vessels from the recipient and donor, the spleen and small intestine removed from the recipient and the femoral artery and the splenic vein removed from it, the operating tables are shifted and the femoral artery shunt, and the iliac spleen vein, respectively, is connected with the ileus by means of shunts, and the iliac spleen artery is connected with the ileus. artery and eponymous vein of the donor. The mesenteric artery and the donor vein are clamped proximally to the branching site of the vessels used for bypass surgery, and at the same time the bloodstream is circulated in the shunts and the blood supply to the small intestine of the donor is provided by the recipient. The transplant is removed from the donor, the operating tables are moved apart and the donor’s intestine is prevented from being removed from the recipient. The vessels of the graft are connected to the vessels of the recipient. Temporary shunts are removed.

Example. The operation of orthotopic transplantation of the small intestine.

The donor and the recipient operate simultaneously two teams of surgeons in the same operating room.

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The first stage is the laparotomy of the donor and the recipient.

The second stage is to mobilize the small intestine of the recipient (1) and the donor (2) below the Trajz ligament, which is 10–15 cm to the ileocecal angle (Fig. 1).

The third stage is the removal of the superior mesenteric artery 3 and vein 4, the splenic vein 5 and the femoral artery 6 from the recipient. Upper mesenteric artery 7 and vein 8, ileo-colic artery 9 and vein 10 at the donor are isolated (figure 1).

The fourth step is to remove the small intestine and spleen from the recipient (Fig. 2) and shift the operating tables.

The fifth stage is connected by means of external shunts, the femoral artery 6 and the splenic vein 5 of the recipient, respectively, with the ileal-colic artery 9 and the same vein 10 of the donor (Fig. 3).

0 Sixth stage - clamp the superior mesenteric artery 7 and the donor's vein 8 proximal to the site of the ileal colic artery 9 and the inflow of the same vein 10. At the same time, remove the clamps from the shunts and start the blood supply to the donor's small intestine from the recipient's body (figure 4).

The seventh stage - remove the small intestine 2 from the body of the donor (figure 5) and push the operating stats. Q The eighth stage is to prevent the small intestine 2 from the donor to the place removed from the recipient (Fig. 6).

The ninth stage is connecting the superior mesenteric arteries of the donor (7) and the recipient (3). The external shunt, the connecting femoral artery 6 of the recipient and the iliac colic artery of the 9 donor intestine, is removed. The iliac-colic artery 9 is ligated, and the defect of the femoral artery 6 of the recipient is sutured (Fig. 7).

The tenth stage is to connect the upper bulbar veins of the donor (8) and the recipient (4). The external shunt, the conjunct splenic vein 5 of the recipient and the ileal-intestinal vein 10 of the donor, remove and tie up the ends of the veins (Fig. 8).

The eleventh stage - impose proximal and distal intestinal anastomoses. Surgical directed reinnervation and relimpatization, fixation of the small intestine of the donor in the body of the recipient 0, is performed. The abdominal cavity is sutured in layers.

The use of the proposed method allows to ensure the continuous blood supply of the small intestine of the donor during the stages of its transplantation, as well as relieves the intestinal organ from the ischemic damage from the donor after it is removed. The use of the method minimizes the likelihood of complications associated with the lack of blood supply to the graft during transplantation and its preservation, in particular, impaired intrastellar circulation in the organ, the development of stromal edema and hemorrhagic necrosis of the graft during and after surgery, which improves the terminal the result of a small bowel transplant operation.

The proposed method can be applied for ortho- and heterotopic transplantation of the small intestine or its segment under conditions of cerebral death of a donor with preserved blood circulation, by using a cardiac massager or an artificial blood-killing machine and when the donor and recipient are located within the same medical institution.

The method can be used in specialized medical and research institutions that carry out small intestine transplantation in experimental and clinical conditions.

Claims (2)

1. A small intestine transplant method, which involves taking a transplant from a donor's body and then restoring the vascular connections of the transplant with the recipient, characterized in that, in order to improve engraftment by providing the recipient's blood with continuous perfusion during the transplantation stages, vessels are transported by temporary external grafts the recipient with the graft vessels distal to the interrupted vascular connections, after the restoration of the vascular connections, the temporary shunts are removed. 2. A method according to claim I, characterized in that the femoral artery and the splenic vein of the recipient are connected with the ileo-colic artery and the same vein of the donor. fig.Z Fi. k 6 FIG. 7 .-; : 4Pk 9 1D