HEPATIC TRANSLANTATION FROM ALIVE DONOR: FIRST EXPERIENCE

S. YILMAZ, J. KAYAALP, N. BAYRAMOV, N. NOVRUZOV

Inonu University, Medical Department, Divison of General Surgery, Malatya, TURKEY

Central Hospital of SCC, Baku, AZERBAIJAN

Materials and method: On 28.11.2010, in our clinic there was performed hepatic transplantation from alive donor. Patients were men at the age of 46 and 49 years. Hepatic cirrhosis developing against the background of viral hepatitis C and viral hepatitis V was considered indication for the operation. The severity of hepatic pathology in patients was determined at the level of 12 points (C) according to Child-Turcotte-Pugh calculation system, and at the level of 19 and 17 points according to Model for End-Stage Liver Disease (MELD) calculation system. Donors were 51 years old woman and 24 years old man.

Results: The weight of right hepatic graft taken for alive donors was 830 and 821 g., donor-recipient ratio of the graft weight was 0,97% and 0,91% respective. The volume of the left lobe left in the both donors constituted >35% of the initial liver parenchyma.

Right hepatic graft was perfused with Histidine-Tryptophan-Ketoglutarate (HTK) solution at the "BACK TABLE" stage and vold ischemia period constituted 60 and 90 minutes. In one patients 7^th segmen vein and middle hepatic vein was reconstructed by frozen vein graft and extended up to the sight hepatic vein, the right hepatic vein was formed as a venous stump with round cryopreserved vein graft and was prepared for anastomosis by the ductoplasty of the two close to 3 bile ducts coming from the right hepatic lobe. In another patient, only the middle hepatic vein was inoculated into the right hepatic vein with frozen venous graft and formed single venous stump, 2 separate bile ducts from the right hepatic lobe were prepared for anastomosis.

In the hepatic artery and other vascular anastomoses, blood flow was assessed by intraoperative ultrasound investigation. After the perfusion of the translanted right lobe, flow was satisfactoru, and parehnchyma had soft and elastic consistence. In the both patients bile duct was restored by duct-to-duct anastomosis over internal drain with distal end coming from the Oddi’s sphyncter. In the post-operative period, 1 patient had bile leak and bile fistula, other patients had small mass in the under-hepatic area, the both complication were treated by conservative methods.

Internal drains inserted into the choledoch were removed endoscopically three months later. Because of a stricture in a biliary anastomosis in 1 patient, a temporary external drain was placed deeply through the bile ducts and 2 months later was replaced by an internally absorbable stent.

In the post-operative period of alive donors, 1 patient had atelectasis, and the other conservatively treated mild hepatocellular dysfunction. Against the immunosuppressive treatment after transplantation, breaking reaction of the transplant was not observed within 8 months and the patients are healthy.

MICROCIRCULATION AND RHEOLOGIC FEATURES OF DUODENAL ULCER DISEASE AGAINST A BACKGROUND OF CHRONIC HEPATITIS B

SH.Y. ZAKIRKHODJAEV, D.A. KARIMOVA, T.A. SAGATOV

Tashkent Medical Academy, Tashkent, UZBEKISTAN

Purpose: Often combined course of duodenal ulcer disease (DUD) and chronic hepatitis B is obvious related to their common blood supply as well as complicated pathogenetic links interrelated and intercaused. In this aspect microcirculatory and rheologic disorders are ones of the important links of pathogenesis of DUD and chronic hepatitis.

Methods: to investigate a state of microcirculation channel of the duodenum. The morphometry method of A.A.Gutsola et al. has been used that is based on determination of common specific density of distributing microvessels in 1 mm² in bioptates. Rheologic features of blood in patients were studied based on determination of blood viscosity and electrophoretic motility of erythrocytes.

Results: Results of study of 35 patients with DUD and chronic hepatitis B showed swelling of mucosal membrane of the duodenum, reinforcement of microphageal and leucocytes’ infiltration as well as desquamation of epithelial cells of ulcerous defect.

Microcirculation channel in stroma of fibri and crypts id fulfilled with blood, vessels had extended passage, precapillaries are filled with blood, and had enlarged passage, diameter by 1.9 times (22,3±1.30 mkm) (control 1,9±0.80 mkm) capillary by 1.80 times (8.9±0.2 mkm) (control 4,9±0.13mkm) postcapillaries by 1,3 times (27.0±1.3 mkm) (control 18.8±1.05 mkm). Parameters of blood viscosity are increasing on an average 48%, but electrophoretic motility of erythrocytes was decreasing by 35% as compared with controls.

Conclusion: Thus, in patients with DUD and chronic hepatitis B in duodenal mucosa side by side with inflammatory destructive changes an uneven enlargement and seldom thin of microcirculation channel were onserved that evidenced an advancing vascular dystonia. At the same time, mucosal capillaries were aneurysmatically enlarged and venous status contributes to developing tissual hypoxia. Disturbances of rheologic parameters of blood is likely to relate with microcirculation disorders in duodenal mucosa, on the one hand and functional disorders in the liver, on other hand.

Date: 2014-12-28; view: 789