METHOD FOR TRANSPLANTATION OF TRACHEAL PULMONARY COMPLEX EXPERIMENTALLY

摘要

FIELD: medicine.;SUBSTANCE: at the first stage, a donor is approached by a complete longer sternotomy and a transverse cervicotomy. A preserving solution is perfused into an aortic arch and a pulmonary arterial trunk. A tracheal pulmonary transplant is removed en bloc with a thyroid gland adjoining the trachea, with the aortic arch and branched bronchial arteries. Soft tissues surrounding the trachea and thyroid gland and comprising inferior thyroid artery and veins are preserved. Posterior and side walls of the left atrium with pulmonary venous entries are preserved. Paratracheal and bifurcation subcutaneously fat is preserved in the form of a pyramid comprising bronchial arteries and veins. A part of the pulmonary trunk is preserved within the bifurcation. The oesophagus is separated from the transplant along the entire length by blunt dissection with sliding motion after a posterior wall of the pericardium is dissected within its junction to the diaphragm. The first stage involves approaching a recipient by the complete longer sternotomy and the transverse cervicotomy. A cardiopulmonary bypass is connected. The trachea is separated and transected in its upper one-third. That is followed by a bilateral pneumoectomy and a resection of the recipient's trachea en bloc. A tracheopulmonary transplanted complex is transferred into the recipient's chest. A posterior mediastinum is tunnelled. The donor's trachea in the complex with the thyroid and thyroid vessels is delivered into the neck area with placing the donor's lungs within the pleural cavities through the pericardial incisions and mediastinal pleura. The donor's and recipient's pulmonary trucks are anastomosed, including the whole posterior and lateral walls of the transplant with the posterior wall of the recipient's left atrium. The donor's and recipient's tracheas are anastomosed within the neck. The donor's lungs are reperfused, and the cardiopulmonary bypass is disconnected. The bronchial and lower thyroid arteries and lower thyroid veins of the donor's complex are sutured to the recipient's vessels for the purpose of revascularisation of the donor's tracheobronchial tree.;EFFECT: method provides the reliable viability of all the structures of the transplanted complex by managing the adequate arterial circulation and venous outflow, and reduces the intraoperative injuries.