SU1500268A1 - Method of simultaneous taking of kidneys and pancreas for transplantation - Google Patents

Abstract

This invention relates to surgery, namely to clinical transplantology. The purpose of the invention is to reduce the time of heat ischemia of the pancreas and kidneys when collecting from the donor, obtaining a graft with a longer vascular pedicle, eliminating the possibility of intestinal damage. At the same time, the thoracic and abdominal cavities are opened by a wide horseshoe-shaped incision with a base at the level of 4-5 ribs along the middle axillary lines to the anterior superior iliac bones with the intersection of the sternum and ribs. The diaphragm areas of the inferior vena cava, the aorta and the esophagus are crossed, the pariental peritoneum in the lumbar region is bluntly peeled, and the posterior diaphragmatic ligaments are crossed. The abdominal complex is eviscerated, the posterior aortic wall is dissected, the celiac trunk and renal arteries are cannulated, and cold perfusion is performed. Then isolation and collection of the kidneys and pancreas is performed. The method shortens the graft release time.

Description

The invention relates to surgery, namely to clinical transplantation, and can be used in operations on the kidney and pancreas intake in a donor donor for subsequent transplantation in the clinic.

The purpose of the invention is to reduce the time of thermal ischemia of organs, to obtain. transplant with a longer vascular pedicle, exclude the possibility of intestinal damage.

The method is carried out as follows.

A large apron-shaped incision of the skin and underlying soft tissues is used to simultaneously open the chest and abdomen. Him

cross the sternum at the level of 4-5 ribs, smoothly turning downwards: intersect the costal arches along the mid-axillary lines and then follow along them to the front superior spines of the iliac bones. Along the skin incision line, the sternum and ribs are cut to the lower edges of the rib arches, dissect the remaining medre- riia muscles and widely open the chest cavity throughout the incision. Then open the pericardium, between the two clips cross the diaphragm of the inferior vena cava. In the same zone, the aorta and the ivodalus are bluntly isolated, which also intersect. Support for the rib arches and the handle of the sternum.

SP

to

Od 00

31500

intersect the posterior diaphragmatic ligaments, bluntly peel the paternal peritoneum from both sides in the lumbar region with their hands and turn the whole complex of abdominal organs together with the aorta and the inferior vena cava anteriorly and downwards. After that, the posterior wall of the aorta is cut longitudinally until its bifurcation, inspecting its visceral branches. The cannulas are inserted into the celiac trunk and the renal arteries, and the clamp is removed from the inferior vena cava to drain the perfusate.

Initially, kidney seizures are performed. For this, the anterior wall of the aorta is cut longitudinally so that, in case of multiple renal arteries, all the vessels of the right and left kidneys with the aortic sites are transferred to the corresponding transplant. The left renal vein (or veins) is cut directly from the inferior vena cava. The shorter vein (or veins) of the right kidney is taken with a larger segment of the inferior vena cava, due to which the kidney vein is subsequently lengthened before transplantation. The ureters are crossed at the entrance to the pelvic cavity, and both future renal grafts are placed separately in containers with a cold preservative. After that, proceed to the direct fence of the pancreas. To do this, remove the cannula from the celiac trunk, the complex of abdominal organs is returned to the abdominal cavity. In the course of an apron-like skin incision, it is cut off and the muscles from the rib arches and open the abdominal cavity. Then, the entire gastric bandage is dissected and the pancreas is exposed. Along the lower edge of its body and tail, the parietal peritoneum is dissected. From the retroperitoneal fiber, the lower edge of the organ is bluntly isolated, then its posterior surface.

all along, fingers separate the body and tail and exit to the upper edge of the gland. The body and tail are finally mobilized, crossing the splenic artery and vein as distal as possible. The gland is held in such a way that the thumb lies on its front surface, and the other four behind. In this case, the celiac trunk is fixed between the index and middle fingers. The pancreas is raised, displaced to the left and intersected between the head and the body. At the same level, cross the short vein. After that, under the fingers, not changing the position of the hand, the celiac trunk is crossed with curved scissors.

According to the proposed method, 35 operations on corpses were performed. The time of thermal ischemia for organs taken averaged 4.5 minutes. The method is recommended for the collection of the kidneys and pancreas from a cadaveric to the burrow, followed by transplantation of these organs in the clinic.

Claims (1)

Invention Formula Method, simultaneous collection of kidneys and the pancreas for transplantation, including thoracoabdominal access, characterized in that, in order to improve the preservation of the graft by reducing the time of excretion and collection, a horseshoe incision is made with a base passing through the midgut of the chest, along the middle axillary line the lower ribs and the posterior legs of the diaphragm, and the peritoneal sac stupidly exfoliate and displace after opening the pericardium and the intersection in the posterior mediastinum of the lower Loi veins, aorta and esophagus.