从已故供体获取多器官的外科技术

F. Kakaei
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摘要

实体器官移植现在是许多类型疾病的标准治疗方法,使用标准的外科技术从已故供体获取器官是预防此类复杂手术后并发症的重要一步。在大多数中心,心脏、肺、肝、肾、小肠、胰腺和其他器官的取出是由不同的外科医生同时完成的,并由一名至少熟悉所有实体器官获取的基本手术技术步骤的团队负责人监督。每个移植外科医生,无论他或她的亚专科,都必须知道如何准备和解剖两个相邻器官之间共同的微妙解剖结构,例如门静脉(肝脏-胰腺),肠系膜上静脉(胰腺-小肠),腹下腔静脉(肝脏-肾脏),膈上下腔静脉(肝脏-心脏)和肺动脉-静脉(心肺)。这需要由最有经验的移植团队成员采取多学科的方法,通过所有外科医生之间更好的协调,在不损害器官的情况下减少器官的热缺血时间。在这一章中,我们简要地描述了一个已故供体的多器官检索程序,我们希望按照这些说明可以在不损害其重要解剖结构的情况下获得更好质量的器官。
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Surgical Techniques of Multiorgan Procurement from a Deceased Donor
Solid organ transplantation is now the standard treatment for many types of diseases and using a standard surgical technique for organ procurement from the deceased donors is an important step in preventing complications after such complicated procedures. In most centers, retrieval of heart, lungs, liver, kidneys, small bowel, pancreas and other organs is done at the same time by different surgeons under supervision by a team leader who is most familiar with at least basic steps of surgical technique of procurement of all the solid organs. Each transplant surgeon, regardless of his or her sub-specialty, has to know how to prepare and dissect the delicate anatomical structures which are in common between the two adjacent organs for example portal vein (liver-pancreas), superior mesenteric vein (pancreas-small bowel), abdominal inferior vena cava (liver-kidneys), supra-diaphragmatic inferior vena cava (liver-heart) and pulmonary artery-veins (heart-lungs). This needs a multidisciplinary approach by the most experienced members of the transplant team to decrease the warm ischemic time of the organs without any harm to them by better coordination between all the surgeons. In this, chapter we briefly describe the multiorgan retrieval procedure in a deceased donor, and we hope that following these instructions results in better quality of the procured organs without jeopardizing their vital anatomical structures.
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Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges Surgical Techniques of Multiorgan Procurement from a Deceased Donor
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