Hloov hauv nruab nrog cev thiab cov nqaij mos. Hloov khoom nruab nrog kev sib hloov nyob rau hauv Russia

hloov khoom nruab nrog tsis txaus teeb meem rau kev sib hloov sai rau tag nrho cov ntawm tib neeg raws li ib tug tag nrho. Hais txog 18 cov neeg tuag txhua txhua hnub uas tsis muaj pub nruab nrog cev thiab nqaij mos mos, thiab tsis tos lawv tig. Hloov khoom nruab nrog kev sib hloov nyob rau hauv lub niaj hnub ntiaj teb no, rau qhov cov ua los ntawm neeg tuag, uas thaum lub sij hawm nws lub neej kos npe rau cov ntaub ntawv ntawm cov kev tso cai rau pub dawb tom qab kev tuag.

Yuav ua li cas yog kev sib hloov

Hloov khoom nruab nrog kev sib hloov yog qhov kev tshem tawm hauv nruab nrog cev los yog nqaij mos mos ntawm lub pub thiab hloov lawv mus rau lub neeg tau kev pab. Lub ntsiab kev taw qhia ntawm kev sib hloov yog sib hloov ntawm tseem ceeb heev kabmob - uas yog, cov neeg tub ceev xwm, tsis muaj uas lub neej yog tsis yooj yim sua. Cov kabmob xws li hauv lub plawv, ob lub raum thiab lub ntsws. Thaum lwm yam kabmob xws li tus txiav, yuav hloov tau hloov txoj kev kho. Raws li ntawm niaj hnub no, kuj zoo kawg kev cia siab rau ib tug extension ntawm ib tug neeg lub neej muab hloov khoom nruab nrog kev sib hloov. Hloov tau tau ntse xyaum. Qhov no hloov siab, raum, siab, cov thyroid caj pas, cornea, tus po, lub ntsws, cov hlab ntsha, daim tawv nqaij, pob txha mos thiab pob txha los ua ib tug lub moj khaum nrog ib tug view mus rau qhov tshiab cov ntaub so ntswg tsim nyob rau hauv lub neej yav tom ntej. Rau cov thawj lub sij hawm ib lub raum hloov mus tshem tawm mob raum tsis ua hauj lwm tus neeg mob tau nqa tawm nyob rau hauv 1954, kev hloov muaj zoo tib yam cov menyuam ntxaib. Hloov khoom nruab nrog kev sib hloov nyob rau hauv Russia twb xub nqa tawm los ntawm Academician Petrovskim B. V. nyob rau hauv 1965.

Yuav ua li cas yog cov sib txawv ntawm cov kev sib hloov

Nyob rau hauv lub ntiaj teb no muaj ntau yam thiaj li terminally mob neeg nyob rau hauv yuav tsum tau ntawm hloov hauv nruab nrog cev thiab nqaij mos mos zoo li raws li kev cai ntawm kev kho mob ntawm daim siab, raum, mob ntsws, lub plawv, muab tsuas yog ib ntus nyem, tab sis tsis hloov fundamentally tus neeg mob tus mob. Hloov khoom nruab nrog kev sib hloov tshwm sim plaub hom. Cov Thawj zaug ntawm lawv - allotransplantation - yuav siv sij hawm qhov chaw nyob rau hauv lub rooj plaub thaum lub pub thiab tau kev pab mus rau tib lub hom, thiab lub thib ob hom yog xenotransplantation - ob qho tag nrho kev kawm mus rau ntau hom. Nyob rau hauv lub rooj plaub uas kev sib hloov ntawm ntaub so ntswg los yog kabmob los ntawm tib menyuam ntxaib los yog tsiaj tsa raws li ib tug tshwm sim ntawm consanguineous pos, lub lag luam yog hu ua izotransplantatsiey. Nyob rau hauv thawj ob tus neeg, tus neeg tej zaum yuav muaj cov ntaub so ntswg rejection, uas yog tshwm sim los ntawm lub cev tiv thaiv ntawm tus kab mob mus rau txawv teb chaws hlwb. Thiab nyob rau hauv lwm yam kev cov ntaub so ntswg nrws feem ntau kawm tau ntawv zoo zoo. Qhov thib plaub hom muaj xws li autotransplantation - hloov ntaub so ntswg thiab kabmob nyob rau hauv ib lub cev.

zaj lus tim khawv

Raws li kev xyaum qhia, txoj kev vam meej ntawm cov neeg ua haujlwm yog lom zem ntau vim raws sij hawm mob thiab yog kev txiav txim ntawm lub xub ntiag ntawm contraindications, raws li zoo raws li cov kabmob hloov tau nqa tawm nyob rau hauv ib tug raws sijhawm. Hloov yuav tsum tau kwv yees nrog rau cov mob ntawm tus neeg mob ua ntej lub lag luam thiab tom qab. Lub ntsiab hais rau phais yog lub xub ntiag ntawm incurable tsis xws luag, kab mob thiab pathologies uas tsis tau kho kho thiab phais txoj kev, raws li tau zoo raws li tuag rau tus neeg mob lub neej. Thaum hloov nyob rau hauv cov me nyuam lub tseem ceeb tshaj plaws nam yog los mus txiav txim lub sij hawm noj rau kev phais. Raws li cov kws txawj ntawm lub tsev raws li lub koom haum ntawm kev sib hloov, postponing phais yuav tsum tsis txhob yuav tsum tau nyob rau hauv lub txhob txwm ntev lub sij hawm, raws li ib tug kev ncua nyob rau hauv txoj kev loj hlob ntawm ib tug hluas lub cev muaj peev xwm ua irreversible. Hloov yog muaj nyob rau hauv cov ntaub ntawv ntawm zoo lub neej raug tom qab lub lag luam nyob rau hauv tus duab ntawm lub pathology.

Hloov hauv nruab nrog cev thiab cov nqaij mos

Nyob rau hauv kev sib hloov, feem ntau ntau autotransplantation, vim hais tias nws yuav rhuav tshem incompatibility thiab cov nqaij mos rejection. Nyob rau hauv feem ntau ua hauj lwm ua nyob rau hauv daim tawv nqaij hloov, lub adipose nqaij thiab nqaij, pob txha mos, pob txha tawg tsam, qab haus huv, pericardium. Thoob plaws leeg thiab leeg tshav hloov. Qhov no twb ua tau ua tsaug rau txoj kev loj hlob ntawm cov niaj hnub microsurgery thiab cov khoom siv rau cov hom phiaj. Qhov zoo kev kawm tau ntawm kev sib hloov yog kev sib hloov ntawm cov ntiv taw mus rau lub ko taw nyob rau hauv txhuam. Los ntawm autologous hloov kuj muaj xws li ntshav ntawm nws cov ntshav loj ntshav poob thaum lub sij hawm kev phais. Thaum allograft feem ntau transplanted hlwb pob txha, hlab ntsha, pob txha cov ntaub so ntswg. Qhov no pab pawg neeg ntawm cov ntshav ntshav kev txhawj xeeb los ntawm cov txheeb ze. Ho tsis tshua ua kev sib hloov phais ntawm lub paj hlwb, raws li ntev raws li lub lag luam no yog txojkev zoo los xij, tab sis cov kev hloov ntawm ib tug neeg feem tsiaj ntse xyaum. txiav hloov tso cai rau koj kom tsis txhob txoj kev loj hlob ntawm xws li ib tug mob loj xws li mob ntshav qab zib. Nyob rau hauv xyoo tsis ntev los, 7-8 nyob rau hauv 10 ntawm cov neeg ua haujlwm yog muaj kev vam meej. Nyob rau tib lub sij hawm tsis tau kiag li transplanted rau hauv tag nrho lub cev, tiam sis tsuas yog ib feem - islet hlwb uas tsim insulin.

Txoj cai nyob rau hauv nrog cev hloov nyob rau hauv Lavxias teb sab Federation

Nyob rau hauv ib ncig ntawm peb lub teb chaws hloov kev lag luam yog tswj los ntawm txoj cai ntawm lub Lavxias teb sab Federation ntawm 22.12.92 "Nyob rau kev sib hloov hauv nruab nrog cev thiab (los yog) tib neeg cov ntaub so ntswg". Nyob rau hauv Russia, feem ntau nqa tawm raum hloov, tej zaum lub plawv, siab. ntawm hloov khoom nruab nrog hloov txoj cai lij choj txiav txim siab no nam raws li ib txoj kev los cawm lub neej thiab noj qab haus huv ntawm cov pej xeem. Txawm li cas los, qhov no tsim muaj feem thib ib considers lub preservation ntawm lub neej ntawm cov neeg uas pub cov ntawm tus neeg tau kev pab txoj kev noj qab haus huv. Raws li Tsoom Fwv Teb Chaws txoj cai lij choj nyob rau hauv kev sib hloov ntawm cov kabmob, tej khoom yuav ua tau pob txha, lub plawv, mob ntsws, mob raum, siab, thiab lwm yam hauv nruab nrog cev thiab cov nqaij mos. Tshem tawm hauv nruab nrog cev yuav raug kwv xws li ib tug nyob tus neeg, thiab lub tuag. Hloov khoom nruab nrog transplantation yog nqa tawm tsuas nrog daim ntawv sau tso cai los ntawm tus neeg tau kev pab. Cov Tuabneeg Paab Nyajtxag tsuas muaj peev xwm sawv cov neeg uas tau undergone kev kho mob soj ntsuam. Hloov khoom nruab nrog kev sib hloov nyob rau hauv Russia yog ua dawb xwb, raws li qhov muag ntawm kabmob yog txwv tsis pub los ntawm txoj cai lij choj.

Cov Tuabneeg Paab Nyajtxag nyob rau hauv kev sib hloov

Raws li lub koom haum ntawm kev sib hloov, txhua tus neeg yuav ua tau ib tug neeg rau khoom hauv nrog cev hloov. Rau cov neeg nyob rau hauv kaum yim xyoo ntawm lub hnub nyoog, koj yuav tsum tau niam txiv kev tso cai rau lub lag luam. Thaum kos npe rau cov kev tso cai rau kev hloov pub dawb tom qab kev tuag mob thiab kev kho mob soj ntsuam, uas tso cai rau koj los mus txiav txim uas kabmob muaj peev xwm yuav transplanted. Cais tawm los ntawm daim ntawv teev cov kev hloov rau hloov hloov thiab cov ntaub so ntswg muaj tus kab mob HIV, mob ntshav qab zib, mob cancer, mob raum, lub plawv thiab lwm yam pathologies. Ib tug uas muaj feem xyuam hloov yog ua feem ntau yog rau paired nrog cev - raum, mob ntsws, thiab unpaired kabmob - siab, plob tsis so tswj, pancreas.

Contraindications rau kev sib hloov

Hloov khoom nruab nrog transplantation muaj ib co contraindications vim mus rau ntawm cov kab mob uas tej zaum yuav exacerbated raws li ib tug tshwm sim ntawm lub lag luam thiab tso hem thawj rau tus neeg mob lub neej, xws li neeg tuag taus. Tag nrho contraindications raug muab faib ua ob pawg: tsis thiab txheeb ze. By tsis muaj xws li:

• kis kab mob nyob rau hauv lwm yam kabmob rau ib tug par nrog cov neeg uas npaj los hloov, nrog rau cov xub ntiag ntawm tuberculosis, AIDS;
• kev cuam tshuam ntawm cov hauj lwm uas tseem ceeb heev kabmob, central lub paj hlwb puas tsuaj;
• qog nqaij hlav;
• lub xub ntiag ntawm malformations thiab yug los tsis zoo, yog tsis tau tshaj rau lub neej.

Txawm li cas los, thaum lub sij hawm lub sij hawm ntawm kev npaj rau qhov phais vim hais tias ntawm cov kev kho mob thiab tshem tawm ntawm ntau cov tsos mob ntawm meej contraindications dhau nyob rau hauv qeb ntawm txheeb ze.

hloov raum

Ntawm kev tseem ceeb nyob rau hauv cov tshuaj yuav siv sij hawm ib tug hloov raum. Vim qhov no yog ib tug khub hloov khoom nruab nrog, nws yog muab tshem tawm ntawm tus neeg pub yog tsis cai mob ntawm lub cev, hem nws lub neej. Vim lub peculiarities ntawm cov ntshav mov rau cov transplanted raum cawm zoo nyob rau hauv tau txais. Thawj thwmsim rau raum hloov tau ua nyob rau hauv cov tsiaj nyob rau hauv 1902, ib tug kev tshawb fawb paub txog E. Ullman. Thaum hloov tau kev pab, txawm nyob rau hauv lub qhaj ntawv ntawm kev kho mob txhawb kom tiv thaiv tsis rau txawv teb chaws hloov nyob ib tug me ntsis ntau tshaj li rau lub hlis. Chiv, transplanted raum nyob rau hauv tus ncej puab, tab sis tom qab uas txoj kev loj hlob ntawm qhov phais twb muaj kev sib hloov phais nyob rau hauv nws hu ua pelvic cheeb tsam, qhov no txoj kev yog xyaum rau hnub no. Tus thawj hloov raum twb ua nyob rau hauv 1954 ntawm zoo tib yam cov menyuam ntxaib. Ces nws twb muaj nyob rau hauv 1959. Lub xyaum ua tej yam ntawm ib lub raum hloov fraternal menyuam ntxaib, thiab cov txheej txheem siv rau counter graft rejection, thiab nws tau pov thawj zoo nyob rau hauv xyaum. tshiab cov cuab yeej uas yuav thaiv lub cev tej mechanisms, xws li azathioprine sab, uas suppresses lub cev tiv thaiv kab mob defenses tau lawm tias. Los ntawm tam sim no nyob rau hauv kev sib hloov tau ua lug siv immunosuppressants.

kev txuag lub cev

Tej qho tseem ceeb heev hloov khoom nruab nrog, uas yog npaj rau kev sib hloov tsis muaj ntshav mov thiab cov pa yog kev kawm mus rau irreversible hloov, tom qab uas nws yog suav tias yog unsuitable rau kev sib hloov. Rau tag nrho cov kabmob, qhov no lub sij hawm yog xam nyob rau hauv ntau txoj kev - rau lub plawv, lub sij hawm yog ntsuas nyob rau hauv feeb, rau ib tug lub raum - ib tug ob peb teev. Yog li ntawd, lub ntsiab yam khoom ntawm lub transplantation yog khaws cia rau hauv lub nruab nrog cev thiab kom lawv cov kev ua tau zoo mus rau hloov mus rau lwm lub kab. Yuav kom daws tau qhov teeb meem no, siv Canning, uas yog los muab lub cev nrog rau oxygen thiab txias. Raum uas koj yuav tseg rau ib tug ob peb hnub. hloov khoom nruab nrog preservation yuav ua rau kom lub sij hawm rau nws kev tshawb fawb thiab kev xaiv ntawm tus tau txais.

Txhua yam ntawm lub cev tom qab tau txais nws tas raug preservation, qhov no yog muab tso rau hauv ib lub taub ntim nrog menyuam tsis taus cov dej khov, ces ua ib tug tshwj xeeb preservation kev daws nyob rau ib tug kub ntawm 40 degrees Celsius. Feem ntau cov feem ntau siv rau cov hom phiaj tshuaj hu ua Custodiol. Perfusion yog suav tag nrho twv thaum lub qhov ncauj ntawm lub hlab ntsha graft protrudes ntshiab ntshav preservative tshuaj tsis muaj impurities. Tom qab no lub cev yog muab tso rau hauv ib lub preservation tov, uas yog sab laug mus rau lub caij ntawm lub lag luam.

hloov rejection

Thaum hloov cov hloov mus rau hauv tus neeg tau kab mob nws yuav tus kwv uas qhov immunological teb. Raws li ib tug tshwm sim, tus tiv thaiv tau kev pab tiv thaiv kab mob cov tshuaj tiv thaiv yuav siv sij hawm qhov chaw ib tug xov tooj ntawm dab nyob rau cellular theem uas ua rau rejection ntawm lub transplanted hloov khoom nruab nrog. Cov dab no yog piav tiam ntawm pub kev tshuaj thiab antigens ntawm tus neeg mob lub cev. Nws muaj ob hom ntawm rejection - humoral thiab hyperacute. Nyob rau hauv mob ntaub ntawv tsim ob rejection mechanism.

Rehabilitation thiab immunosuppressive kev kho mob

Yuav kom tiv thaiv no sab nyhuv ntawm tus immunosuppressive txoj kev kho yog kho nyob ntawm seb lub hom ntawm lub lag luam, cov ntshav pab pawg neeg, cov neeg kawm ntawv ntawm compatibility ntawm lub pub thiab tau kev pab, thiab tus neeg mob tus mob. Tus me tshaj rejection cai nyob rau hauv lwm yam kev hloov hauv nruab nrog cev thiab cov nqaij mos, raws li nyob rau hauv cov ntaub ntawv no, raws li ib tug txoj cai, 3-4 antigen los ntawm 6 coincide. Yog li ntawd, ib tug me me koob tshuaj ntawm immunosuppressants. Qhov zoo tshaj plaws ciaj sia taus qha siab hloov. Xyaum qhia tau hais tias lub cev qhia tau hais tias ib tug ntau tshaj li kaum-xyoo ciaj sia taus tus nqi tom qab phais nyob rau hauv 70% ntawm cov neeg mob. Heev cov tshuaj tiv thaiv ntawm tus neeg thiab graft microchimerism tshwm sim, uas lub sij hawm maj mam txo cov tshuaj ntawm immunosuppressants kom txog thaum tiav rejection ntawm lawv.