[共享] 一组移植供体手术图片
这个帖子发布于 18 年零 81 天前，其中的信息可能已发生改变或有所发展。
借花献佛，送给对移植有兴趣的朋友。
Organ Procurement from Cadaveric Donors
Figure 1. Incision used for multiple organ procurement. The incision used for multiple organ procurement is made from the suprasternal notch to the pubis. The falciform ligament is divided and the pericardium opened.
Figure 2. Division of gastrohepatic ligaments. The left triangular and gastrohepatic ligaments are divided so that the left lobe of the liver can be retracted to the right. The diaphragmatic crura are divided between the esophagus and the vena cava to facilitate exposure and encirclement of the aorta at the level of the diaphragm.
Figure 3. Exposure of distal aorta. The small intestine is reflected, the distal aorta is exposed, and the inferior mesenteric artery is ligated and divided. Catheters are inserted into the inferior mesenteric vein and into the distal aorta.
Figure 4. (click image to zoom) Cross-clamping of aorta. The aorta is cross-clamped at the diaphragmatic level and at the arch level in the chest at the time of rapid infusion.
Figure 5. Procurement of heart. The heart is procured by dividing the aorta at the level of the arch and the suprahepatic vena cava with care taken to leave adequate caval length with both the heart and the liver.
Figure 6. Procurement of heart and lungs. Shown is en bloc procurement of heart and lungs.
Figure 7. Junction of superior mesenteric vein and splenic vein. The junction of the superior mesenteric vein and the splenic vein is behind the pancreas, as depicted here. Cannulas are shown in the inferior mesenteric vein and the distal aorta.
Figure 8. Replaced right hepatic artery. The typical replaced right hepatic artery originates from the first 2 cm of sected portal vein reflected. Also shown is the Carrel patch that will later be created to preserve the celiac axis and the SMA (dashed red line).
Figure 9. Division of lateral attachments to spleen and pancreas. With the lateral attachments to the spleen and the pancreas divided, the entire pancreaticosplenic complex can be reflected medially. The aorta is thereby exposed and can be incised anteriorly at the level of the SMA so that the orifices of both renal arteries can be identified and preserved (inset).
Figure 10. Procurement of pancreas. The pancreas is procured with a segment of duodenum. Shown is the posterior view of the pancreas and duodenum, with the spleen removed. The arterial reconstruction involves using a Y-shaped donor iliac artery graft and anastomosing it to the donor superior mesenteric and splenic arteries. Occasionally a vein graft (not shown) is needed for use as an extension graft for the portal vein.
Figure 11.In situ separation of intestinal, pancreatic, and hepatic grafts. Shown is in situ separation of intestinal, pancreatic, and hepatic grafts. The mesenteric dissection is performed at the level of the middle colic vessels, with care taken to preserve the inferior pancreaticoduodenal artery and vein with the pancreatic graft. The aorta is divided just distal to the SMA and just proximal to the renal arteries.
Figure 12. En bloc nephroureterectomies. Shown are en bloc nephroureterectomies being performed from below upward (i.e., cranial to caudal).
Figure 13. Opening of aorta. The aorta is opened posteriorly between the paired lumbar arteries.
Organ Procurement from Cadaveric Donors
Figure 1. Incision used for multiple organ procurement. The incision used for multiple organ procurement is made from the suprasternal notch to the pubis. The falciform ligament is divided and the pericardium opened.
Figure 2. Division of gastrohepatic ligaments. The left triangular and gastrohepatic ligaments are divided so that the left lobe of the liver can be retracted to the right. The diaphragmatic crura are divided between the esophagus and the vena cava to facilitate exposure and encirclement of the aorta at the level of the diaphragm.
Figure 3. Exposure of distal aorta. The small intestine is reflected, the distal aorta is exposed, and the inferior mesenteric artery is ligated and divided. Catheters are inserted into the inferior mesenteric vein and into the distal aorta.
Figure 4. (click image to zoom) Cross-clamping of aorta. The aorta is cross-clamped at the diaphragmatic level and at the arch level in the chest at the time of rapid infusion.
Figure 5. Procurement of heart. The heart is procured by dividing the aorta at the level of the arch and the suprahepatic vena cava with care taken to leave adequate caval length with both the heart and the liver.
Figure 6. Procurement of heart and lungs. Shown is en bloc procurement of heart and lungs.
Figure 7. Junction of superior mesenteric vein and splenic vein. The junction of the superior mesenteric vein and the splenic vein is behind the pancreas, as depicted here. Cannulas are shown in the inferior mesenteric vein and the distal aorta.
Figure 8. Replaced right hepatic artery. The typical replaced right hepatic artery originates from the first 2 cm of sected portal vein reflected. Also shown is the Carrel patch that will later be created to preserve the celiac axis and the SMA (dashed red line).
Figure 9. Division of lateral attachments to spleen and pancreas. With the lateral attachments to the spleen and the pancreas divided, the entire pancreaticosplenic complex can be reflected medially. The aorta is thereby exposed and can be incised anteriorly at the level of the SMA so that the orifices of both renal arteries can be identified and preserved (inset).
Figure 10. Procurement of pancreas. The pancreas is procured with a segment of duodenum. Shown is the posterior view of the pancreas and duodenum, with the spleen removed. The arterial reconstruction involves using a Y-shaped donor iliac artery graft and anastomosing it to the donor superior mesenteric and splenic arteries. Occasionally a vein graft (not shown) is needed for use as an extension graft for the portal vein.
Figure 11.In situ separation of intestinal, pancreatic, and hepatic grafts. Shown is in situ separation of intestinal, pancreatic, and hepatic grafts. The mesenteric dissection is performed at the level of the middle colic vessels, with care taken to preserve the inferior pancreaticoduodenal artery and vein with the pancreatic graft. The aorta is divided just distal to the SMA and just proximal to the renal arteries.
Figure 12. En bloc nephroureterectomies. Shown are en bloc nephroureterectomies being performed from below upward (i.e., cranial to caudal).
Figure 13. Opening of aorta. The aorta is opened posteriorly between the paired lumbar arteries.
