TRANSPLANTATION OF THE REVASCULARIZED TRACHEA IN THE EXPERIMENT AND, FURTHER, IN THE CLINIC WITH A GOOD REMOTE RESULT

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Transplantation of vital organs has now become a daily reality. However, unlike many other organs, in clinical practice there is no reliable transplant of the trachea, capable of replacing it with total lesion. This is due to the peculiarities of the anatomy of the trachea, as well as its constant contact with the external environment, leading to infection of the trachea. The goal of the research was to develop an anatomical model of transplantation of a revascularized trachea with the aim of its clinical use for the tracheal defects replacement after extensive resection. In the anatomical theater were performed 109 experiments in which the anatomy of the vascular pedicle of the trachea was studied, the area of perfusion of the tracheal wall through the thyroid arteries was determined. Thus was developed a new method of transplantation of the revascularized trachea in the composition of the thyreotrial complex. Was developed the donor selection stage of the organ, which was carried out in 17 cases. Preference was given to the «fast» version of the fission of the thyreotrial complex, which is convenient to use in the multi-organ fence in the donor after the death of the brain. Recipient stage (n=5) was performed after subtotal resection of its own trachea. The blood supply was restored by superimposing vascular anastomoses of the lower thyroid arteries and the veins of the donor complex with the receptor vessels. The choice of recipient vessels was carried out individually in each specific case, depending on the location of mediastinal and transplant structures. In the experiment were determined on animals the permissible time of thermal ischemia of the thyreotrial complex, the preservative solution and the features of reperfusion injury. Thus, for the first time a technique for transplantation was proposed of the trachea in the composition of the thyreotrial complex with one-stage revascularization through the lower thyroid vessels. This technique used us in the clinic. The patient is a 37-year-old man with a diagnosis The operation was done for 37-year-patient with diagnosis: «Afterthracheostomic subtotal cicatricial stenosis and malacia trachea. The membranous part defect of thoracic trachea with the formation of false way into mediastinum. Mediastinitis. Tracheostomy. Chronic tracheobronchitis». The stage of withdrawal of the thyreotrial complex was carried out according to the developed protocol. Perfusion of the organ was made with a solution of «Custodiol». The recipient stage of transplantation consisted of a resection of a cicatricial trachea. The upper border of resection was at the level of the first intercropping interval, the lower one - along the upper right edge of the last cartilaginous half-ring, the resection of the tracheobronchial angle was performed along the left wall. Further, caudal and cranial tracheotraal anastomoses were performed between the donor complex and the trachea of the recipient. To restore blood circulation an anastomosis of the left and right lower thyroid arteries with a brachiocephalic trunk of the recipient was performed in the type of «end-to-side». The bloodstream was restored by an anastomosis of the lower thyroid vein of the donor with the left brachiocephalic vein of the recipient. In the postoperative period were prevented infectious complications and rejection. When analyzing the structure of the tracheal part of the graft, the preservation of the mucosa and the cartilaginous carcass was revealed in the near and distant periods after the operation, while maintaining a satisfactory lumen of the respiratory tract. At present, after 12 years the recipient is alive, breathing is satisfactory. In the late period, the development of malacia trachea was diagnosed. This required the stenting of the trachea, which the patient carries well. Thus was made a preclinical study devoted to the solution of tracheal transplantation. The implementation of the proposed technique of thyrotrheic transplantation in a clinic with a good long-term result and a follow-up period of 12 years showed the validity of the method in the treatment of patients with extensive tracheal lesion with the impossibility of alternative treatment. Disadvantage should be considered the need for immunosuppressive therapy.