zdmeЗдоровье мегаполисаCity Healthcare2713-2617ГБУ «НИИОЗММ ДЗМ»10.47619/2713-2617.zm.2020.v1i1;38-50zdme-229Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHESНовые хирургические подходы к трансплантации поджелудочной железыNew surgical approaches to pancreas transplantationhttps://orcid.org/0000-0001-9019-9567ПинчукА. В.PinchukA. V.

Пинчук Алексей Валерьевич – доктор медицинских наук, заведующий научным отделением трансплантации почки и поджелудочной железы

129090, Москва, Б. Сухаревская пл., д. 3.

Alexey V. Pinchuk − PhD, the head of kidney and pancreas transplantation science department

3, Bolshaya Sukharevskaya Sq., 129090, Moscow

https://orcid.org/0000-0002-3041-7478АнисимовЮ. А.AnisimovY. A.

Анисимов Юрий Андреевич – врач-хирург отделения трансплантации почки и поджелудочной железы

129090, Москва, Б. Сухаревская пл., д. 3.

Yuriy A. Anisimov − surgeon of kidney and pancreas transplantation department

3, Bolshaya Sukharevskaya Sq., 129090, Moscow

dranisimovsclif@gmail.comНИИ скорой помощи им. Н. В. Склифосовского ДЗМN.V. Sclifosovsky Research Institute of Emergency Medicine202003032020113850Copyright © Пинчук А.В., Анисимов Ю.А., 20202020Пинчук А.В., Анисимов Ю.А.Pinchuk A.V., Anisimov Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.city-healthcare.com/jour/article/view/229

Введение. Основными спорными техническими вопросами пересадки поджелудочной железы остаются варианты отведения панкреатического сока от пересаженного органа, а также способы его артериальной реконструкции для обеспечения адекватного и полноценного кровоснабжения трансплантата. В статье описан наш опыт внедрения в клиническую практику двух новых технических вариантов трансплантации поджелудочной железы: с бескультевым дуоденальным дренированием и с изолированным ее кровоснабжением по селезеночной артерии. Материалы и методы. Предлагаемая нами операция с бескультевым дуоденальным дренированием панкреатического сока по методике button-technique позволяет минимизировать осложнения, обусловленные травмой двенадцатиперстной кишки, и снизить антигенную нагрузку. Аппаратный способ формирования межкишечного соустья позволяет создать равномерную компрессию по линии анастомоза, обеспечивает прочность и герметичность шва, точное сопоставление ткани, а возможность регулировки закрытия скобок способствует надежному гемостазу тканей различной толщины. Результаты. Модифицированная техника трансплантации поджелудочной железы с изолированным кровоснабжением по селезеночной артерии может быть использована как при невозможности выполнения общепринятой артериальной реконструкции трансплантата, так и в качестве рутинной процедуры, поскольку адекватная и достаточная гемоперфузия всех частей панкреатодуоденального трансплантата при его изолированном кровоснабжении по селезеночной артерии обоснована и возможна ввиду наличия развитой системы коллатералей между бассейнами селезеночной и верхней брыжеечной артерий.

Background. The main controversial technical issues of pancreas transplantation are kinds of diverting pancreatic secret from the transplanted organ, as well as methods of its arterial reconstruction to ensure adequate and full blood supply of the graft. The article describes our experience in introducing two new technical variants of pancreas transplantation into clinical practice: with stump-free duodenal drainage and with its isolated blood supply by the splenic artery. Materials and methods. Our proposed operation with stump-free duodenal drainage of pancreatic secret using the button-technique method allows to minimize complications caused by duodenal injury and to reduce the antigenic load. The hardware method of forming the intestinal anastomosis allows to create a uniform compression along the line of anastomosis, provides strength and tightness of the seam, accurate tissue comparison, and the ability to adjust the closure of the brackets contributes to reliable hemostasis of tissues of different thickness. Results. The modified technique of pancreas transplantation with isolated blood supply through the splenic artery can be used both when it is impossible to perform the generally accepted arterial reconstruction of the graft, and as a routine procedure, since adequate and sufficient hemoperfusion of all pancreatoduodenal graft’s parts with its isolated blood supply through the splenic artery is justified and possible due to the presence of a developed system of collaterals between the splenic and superior mesenteric arteries.

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The authors declare that there are no conflicts of interest present.