| 摘要 |
FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, specifically to surgery, and can find application in hepatic transplantation. The preoperative planning of orthotopic cadaveric hepatic transplantation involves computer tomography of liver of a potential recipient followed by three-dimensional image reconstruction to estimate for postcava patency and diametres of hepatic veins. If there is no need to plan the intervention including the recipient's postcava resection, in case stenosis is observed at least in one postcava department, as provided on the reconstructed tomograms, vertical planes are constructed through the central axes of right, middle and left hepatic veins with and angle detection in-between. Horizontal planes are constructed through the mouth centres of three hepatic veins to evaluate the distance of maximally spaced planes, and if the angle between the vertical planes constructed through the central axes of the right and left hepatic veins less than 120, while total diametre of three unified hepatic veins is not less 20 mm, and the distance of maximally spaced horizontal planes drawn through the centres of three hepatic veins is no more than 10 mm with any angles between the vertical planes drawn through the central axes of right and middle, as well as middle and left hepatic veins, orthotopic hepatic transplantation is supposed to preserve the recipient's postcava with forming a piggy-back cava-caval anastomosis with three hepatic veins. If the angle between the vertical planes constructed through the central axes of the right and left hepatic veins is 120 and more, and between those drawn through the central axes of middle and left hepatic veins is less than 120, the distance of horizontal planes drawn through the mouth centres of middle and left hepatic veins is no more than 10 mm, while total diametre of middle and left hepatic veins is not less than 20 mm, and under any other conditions, the planned intervention shall include preservation of the recipient's postcava and formation of piggy-back cava-caval anastomosis with middle and left hepatic veins. If the angle between the vertical planes constructed through the central axes of the right and left hepatic veins is 120 and more, and between those drawn through the central axes of middle and left hepatic veins is less than 120, distance of the maximally spaced horizontal planes constructed through the mouth centres of three hepatic veins is more than 10 mm, and of those constructed through the mouth centres of middle and left hepatic veins is no more than 10 mm, total diametre of middle and left hepatic veins is less than 20 mm, the intervention is planned to preserve the recipient's postcava and to form piggy-back cava-caval anastomosis with middle and left hepatic veins and a part of anterior postcava wall. If the distances between all horizontal planes drawn through the centres of hepatic veins exceed 10 mm and diametre of at least one of them is 20 mm with any other parametres, or if the angle between the vertical planes through the central axes of hepatic veins total diametre of which makes 20 mm, exceeds 120 with any other parametres, the intervention shall involve preservation of the recipient's postcava and formation of cavastomy anastomosis. ^ EFFECT: method improves accuracy of preoperative planning of orthotopic hepatic transplantation type, provides adequate preparation of equipment in the operating room and anesthesiology team membership with higher safety and reduced operation time. ^ 6 ex |
