器官移植的发展与未来ppt课件

1、器官移植的發展與未來台北榮總 普通外科龍藉泉.Human chimera, or “ homo novo. Mans original structure has been modified so that he can accept an organ “ from elsewhere .Myth and Legend.Myth and Legend.Myth and Legend.Myth and LegendProf. V.Demikhov and his two-headed dog. photo taken two days after the operation U.S.S.R (1

2、950).MAIN STEPS IN GRAFT HISTORYTHE PLANT GRAFT: VERY EARLY IN MANS HISTORYTHE ANIMAL GRAFT: 18TH CENTRURYTHE HUMAN GRAFT: 18TH CENTURYORGAN TRANSPLANTATION: 20TH CENTURY.FROM GARDEN TO FARMYARD.FROM GARDEN TO FARMYARD.19TH CENTURY: ALL FROMS OF GRAFTSBoronios sheep (1804). Successful replacement sk

3、in grafts on the back of an ewe.Paul Bert next to Claude Bernard, performing a vivisection procedure in his laboratory at the College of France in 1889.Free split-skin graft on a burn of the shoulder and arm.THE KIDNEY: A PILOT ORGAN.THE FIRST TRANSPLANTATION IN ANIMAL At the Vienna Medical Society

4、meeting held in January 1902, the surgeon Emerich Ullmann reported the first case of renal transplantation performed in the neck of a dog. The ureter, brought out to the skin , oozed a “ liquid which resemble urine over a period of five days.Dr. Alexis Carrel A magician.First renal transplantations

5、in man : 1906-1913In 1906, Mathieu Jaboulay performed renal transplantation in man.He transplanted the left kidney of a pig, killed 3 hours previously, into the left elbow of a woman suffering from nephrotic syndrome.The graft removed on the third day and the vessels were found to be obstructed by c

6、lots.First transplantation between humans : 1933In 1933, the russian surgeon Voronoy (1896-1961) performed the first homologous renal transplantation in man using a human cadaver kidney.Serge Voronoff, at the Collge de France. Testicular transplantation from a monkey to man. A retired indian army co

7、lonel in fine form after the operation.The Brigham commando : 1947A young woman was in profound coma with anuria for 10 days following an abortion complicated by acute tubulopathy due to septic shock and incompatible transfusion.David M. Hume (1917-1973).Paris, Christmas 1952 : the present from a mo

8、ther to her sonMrs Renard and her son Marius to whom she donated a kidney in December 1952.Pelvic implantation of the kidney with restoration of the urinary tract.A real Success : 1954John Merrill and Joseph Murry (Nobel Prize 1991) at the Brigham in 1953First susccessful transplantation between two

9、 identical twins in 1954 by the Murry, Merrill and Harrison team.Peter Brian Medawar, Nobel Prize in 1960.Rejection was by the action of lymphocytes which described as “ immunocomeptent cells “.MAJOR HISTOCOMPATIBILITY COMPLEX : 1952( Jean Dausset, Nobel Prize in 1980 )( Human MHC ).Immunosuppressio

10、n : Total Body Irradiation“Sam and “Honest John.First prolonged survival of renal transplantation with an unrelated donorMrs Gen and her donor at Foch Hospital in 1960.Development of Immunosuppressive DrugsMarianne Mattlaer with “Mana, who received a kidney in 1960 with immunosuppression by azathiop

11、rine, with a litter tow years after the transplantation.Advent of CyclosporineThe primitive fungus from which cyclosporine is extracted (Tolypocladium inflatum)Sir Roy Calne.Progress in Hemodialysis William J. Kolff, father of the artificial kidney and heart. The first artificial kidney designed by

12、Kolff in 1945.Tissue Typing“The centre effect: Terasaki and statistics.Organ PreservationFalkert O. Belzer. The first human kidney preserved on a perfusion machine prior to transplantation in August 1967.Organ Preservation.Liver TransplantationThomas Starzl in the operating room on March 1, 1963, pe

13、rformed the first liver transplantation, the recipient survived five hours after the transplantation.Oil painting by Sir Roy Calne (1990) represent a phase of liver transplantation coordinated by the entire surgical team.Pancreas and Intestinal TransplantationRichard Lillehei.Heart and Lung Transpla

14、ntationDenise Darvall, the first human heartdonor Louis Washkansky, the heart recipient. December 3, 1967.Christiaan N. Barnard, cardiovascular surgeon at Capetown.Artificial Heart.Heart and Lung TransplantationJames D. Hardys team, performed the first human lung transplantation on June 11, 1963, se

15、ven and a half months before they performed the first human heterologus heart transplantation.XenotransplantationThe first blood transfusion from animals to man were attempted in 1628.Xenotransplantation.器官移植在臺灣的發展腎臟 1968.05.27 台大 李俊仁自體骨髓 1983.11.09 台大 陳耀昌異體骨髓 1984.03.09 台大 陳耀昌肝臟 1984.03.22 長庚 陳肇隆胰臟

16、 1984.04.01 長庚 陳肇隆心臟 1987.07.17 台大 朱樹勳肺臟 1991.07.10 北榮 王良順.台灣器官移植之父.台灣肺臟移植的先驅王良順教授，台北榮總呼吸加護病房主任.How the transplantation is doing?.How the transplantation is doing?.SPKTFrom Donor to Recipient From 8 AM to 2 AM 09/20/2003.Liver and Pancreas in Back Table.Y-graft ReconstructionSMASAEIAIIACIA.Pancreas TransplantationCold/Warm Ischemic Time = 452 min/38 minPVDuodenum graftY-graft a.Pancreas graft.Duodeno-jejunostomy in SPKTPancreas.SPKT on 09/19/2003Pancreatico-Duodenal graftKidney graftJejunum.First 24 hours Blood Sugar after SPKT.First Month Blood