Briceño Javier, Sánchez-Hidalgo Juan Manuel, Arjona-Sanchez Alvaro
Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain.
World J Transplant. 2021 Jan 18;11(1):1-6. doi: 10.5500/wjt.v11.i1.1.
To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor technique. Back-table surgery for pancreatic graft is a complex, meticulous and laborious technique on which the success of implant surgery and perioperative results depends. The technique can be described in the following steps: Preparation of the sterile table, inspection of the pancreas-spleen block, management of the duodenum, identification of the bile duct, preparation of the portal vein, preparation of the own graft arteries and anastomosis to the arterial graft, spleen management and graft preservation prior to implantation in the recipient. A careful inspection of the pancreas-spleen block should be performed. It is important to identify the stump of the main bile duct, the portal vein cuff, and the arrangement of the superior mesenteric artery and splenic artery. The redundant duodenum must be removed. The availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft, two key points to prevent thrombosis. The section line of the arteries must be clean, without atherosclerosis, to prevent arterial thrombosis. The superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic tissue. The artery can be reconstructed by interposing a "Y" graft from the donor iliac artery; or with an end-to-end anastomosis between the splenic artery and the superior mesenteric artery. An exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation: Thrombosis and graft pancreatitis.
描述胰腺移植后台手术的主要方面以及技术欠佳所引发的问题。胰腺移植后台手术是一项复杂、精细且费力的技术，植入手术的成功及围手术期结果均取决于此。该技术可按以下步骤描述：准备无菌手术台、检查胰脾块、处理十二指肠、识别胆管、准备门静脉、准备自体移植动脉并与动脉移植物吻合、处理脾脏以及在植入受者前保存移植物。应仔细检查胰脾块。识别胆总管残端、门静脉袖套以及肠系膜上动脉和脾动脉的排列非常重要。必须切除多余的十二指肠。良好的静脉袖套有助于门静脉吻合及移植物定位，这是预防血栓形成的两个关键点。动脉的切断线必须干净，无动脉粥样硬化，以防止动脉血栓形成。肠系膜上动脉和脾动脉通常被致密的纤维淋巴组织分隔。动脉可通过插入供体髂动脉的“Y”形移植物进行重建；或者脾动脉与肠系膜上动脉进行端端吻合。精湛的台上操作技术有助于预防胰腺移植最可怕的并发症：血栓形成和移植胰腺炎。
