猪门静脉转流下胰十二指肠切除及肠系膜上静脉-门静脉切除重建的研究  

Study of pancreaticoduodenectomy in combination with resection of the superior mesenteric-portai vein and reconstruction of portal vien in pig

作　　者：赵建勇[1] 董家鸿[2] 韩本立[2] 王槐志[2] 杨占宇[2] 冯小兵[2] 

机构地区：[1]贵阳市第一人民医院肝胆外科,550002 [2]第三军医大学西南医院肝胆外科医院

出　　处：《中华实验外科杂志》2004年第8期914-916,共3页Chinese Journal of Experimental Surgery

摘　　要：目的 探讨门静脉转流下胰十二指肠切除(PD)及肠系膜上静脉-门静脉(SMPV)切除重建的可行性及安全性,并对其评价。方法 利用猪与人胰腺解剖的相似性,用来模拟人的胰头癌浸润SMPV后的胰十二指肠切除方式,建立门静脉转流下PD及SMPV切除重建的技术及方法。结果 (1)实验组、对照组长期存活率分别为100.0％、66.7％;(2)对照组阻断前后血流动力学参数波动较大,实验组稳定;(3)两组均有肝脏缺血再灌注损伤,但对照组病理损害比实验组重;(4)实验组肠黏膜的病理损害明显轻于对照组;(5)对照组肠黏膜通透性、肠系膜淋巴结肠道菌属培养阳性率及门静脉血内毒素均明显高于实验组。结论 在门静脉转流下,猪胰十二指肠切除联合SMPV切除及自体颈外静脉移植,其操作简便,安全性大,是研究临床手术方式比较实用的技术方法。Objective To explore the model of construction of pancreaticoduodenec- tomy (PD) in combination with resection of superior mesenteric-portal vein (SMPV) and the method of the reconstruction of portal vein. Methods To mimic human pancreaticoduodenectomy in combination with resection of the SMPV and reconstruction of portal vien in patients with pancreatic head cancinoma invading SMPV under veno-venous bypass, the animal model of this operation was established in Rongchang pigs based on the same anatomical structure between human and pig. Results (1) Survival rate in the experimental group and control group was 100.0 % and 66.7 % respectively; (2) The hemodynamics in control group after PV clamping was quite different from that after PV unclamping, but was stable in experimental group; (3) Ischemia-repurfusion injury on liver occurred in both groups. The pathological changes of liver in control group were greater than those in veno-venous bypass; (4) Intestinal mucosa membrane pathological impairment in experimental group was obviously less than in control group;(5) The permeability of intestinal mucosa membrane, positive rate of mesenteric lymph node bacterial cultures and portal venous lipopolysaccharide (LPS) concentration were higher in control group than in experimental group. Conclusion Pancreaticoduodenectomy in combinatioin with resection of SMPV and reconstruction of portal vien under veno-venous bypass in pigs is safe and simple. It is an ideal animal model that can be used in clinical research.

关 键 词：胰十二指肠切除 对照组 门静脉转流 肠系膜上静脉 病理损害 实验 PD 解剖 结肠 阳性率 

分 类 号：R735.9[医药卫生—肿瘤]