Qaraciyər transplantasiyasında donor əməliyyatı (şəkillərdə)

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Op.Dr.Kamran Beydullayev, MRCS İngiltərə, Ümumi və Transplant Cərrah, Əlaqə nömrəsi 0504063853

Donorun əməliyyat stolunda vəziyyəti.
CUSA cihazı parenximanın disseksiyasında istifadə edilir.
İnstrumentlər stolu
Sağ tərəfli hepatektomiya üçün kəsik

2.5 dəfə böyüdücü luplar daha dəqiq görüntü verir
Falciform və Coranal bağlar kəsilir.
Qaraciyərlə aşağı boş vena arasındakı kiçik qaraciyər venaları bağlanır, kəsilir
Makuçi liqamenti kiçik gloverlərlə tutulub kəsilir və tikilir.
Sağ hepatik vena asqıya alınmaq üçün dissektorla dönülür
Sağ hepatik vena penrose asqısı ilə asılıb. daha aşağda 6 cı seqmenti drenaj edən aksesuar vena görsənir. Bu vena əməliyyatın axırına qədər saxlanırv və qorunur. Resipient tərəfdə bu vena da anastomoz ediləcək.
Qaraciyər qapısı disseksiya edilir. Şəkildəki öd kisəsi arteriyasıdır.
Öd kisəsi axarı da asqıya alınıb
Sağ qaraciyər arteriyası dissektorla dönülüb. Fərqli olan tərəfi sağ qaraciyər arteriyasının xoledoxun önündən keçməsidir. Bu tez tez rast gəlinən variasiya deyil.
Sağ portal vena asqıya alınır
Sağ portal vena və arteriya sıxıldıqda qaraciyərin səthinə demarkasiya xətti alınır. parenxima bu xətt boyunca disseksiya edilir.
Parenxim disseksiyası
Parenxim daxilindəki xırda damarları bağlaamaq üçün metal kliplərdən istifadə edilə bilər
Parenximanı disseksiya etmək üçün Clamp Crush üsulundan və ya CUSA dan istifadə etmək olar. Şəkildə Kelli alətinin köməyi ilə parenxima əzilir.
CUSA
Parenxim disseksiyası sağ öd yolları yatağına çatdıqda yataq sağ arter və portal vena ilə bərabər dönülərək penrose rezin önə tərəfə keçilir. Bu manevr sağ qaraciyər elementlərini qorumaqla parenxim disseksiyasını bitirməyə imkan verir.
Penrose asqı parenximanın aşağı boş venadan aralanmasına şərait yaradır və bu da ikincinin disseksiya zamanı zədələnməsinə mane olur.
Parenxim disseksiyası bitdikdən sonra öd kisəsi axarı kanyulasiya edilir və əməliyyatdaxili xolangioqrafiya üçün hazırlanır.
Kəsik xəttini ayarlamaq üçün sağ öd yolları yatağına iri kliplər qoyulur. Xolangioqrafiyada bu kliplər haradan kəsməli olduğumuzu göstərəcək
Xolangioqrafiya üçün C-arm rentgen cihazından istifadə edilir.
Bu şəkildən kəsəciyimiz xətti təsvir edə bilərik
Sağ öd yolları kəsilir
Sağ arter kəsilir
Sağ porta Pott sıxıcıları ilə tutulur və kəsilir
Aksesuar qaraciyər venası və Sağ qaraciyər venası glover sıxıcıları ilə tutularaq kəsilir
Resipient tərəfə verilməzdən öncə orqan tərəzidə çəkilir
Damarların və öd yollarının güdülü növbə ilə tikilir
Daha bir əməliyyatı uğurla başa vurmuş donor komandası

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