猪同种异体胰十二指肠移植门静脉回流肠内引流模型治疗工型糖尿病的实验研究  

Whole panereatoduodenal allotransplantation model with jejunmn drainage and portal vein drainage for treatment of type Ⅰ diabetes in pigs

作　　者：韩方海[1] 张肇达[1] 胡伟明[1] 孟令祥[1] 周详[1] 陆慧敏[1] 

机构地区：[1]四川大学华西医院普通外科,成都市610041

出　　处：《中华肝胆外科杂志》2007年第1期48-51,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：博士点基金资助课题20030610071,CMB资金赞助82412

摘　　要：目的建立稳定、可靠、符合解剖生理的猪胰十二指肠移植模型。方法选四川当地杂种长白猪46头（体重25-32kg），分为供受体两组（n=20），进行同种异体胰十二指肠移植手术。供体全身肝素化，用UW液从腹主动脉灌注、门静脉流出，压力80-100cmH2O。切取供体的胰十二指肠，修剪供体、供体髂总动脉及髂内、外动脉分别与移植胰腺的腹腔动脉和肠系膜上动脉“Y”型吻合。切除受体胰腺建立Ⅰ型糖尿病模型。供体的门静脉与受体的肠系膜上静脉或门静脉端-侧4吻合；呈“Y”形的髂总动脉与受体腹主动脉端-吻合；供体的十二肠与受体的空肠侧-侧吻合。颈外静脉切开置管，术后输液。观察术后手术合并症，术中，术后1～7d检测血糖、胰岛素、胰高血糖素水平，移植物存活，急性排斥反应。结果进行猪同种异体胰十二指肠移植23例，手术中因麻醉意外死亡1例，手术成功率为95．6％。发生手术合并症2例，其中静脉血栓形成1例，发生率为4．6％。十二指肠空肠吻合口漏1例，发生率4．6％。在切除胰腺30min可见血糖升高，手术后第2天开始恢复正常水平。胰岛素和胰高血糖素在切除胰腺30min内开始下降，术后第2天开始恢复正常水平。术后第1天开始出现排斥反应，且逐渐加重，第7天达到高峰，但是未出现血糖、胰岛素、胰高血糖素水平变化和排斥反应的临床症状。结论门静脉回流＋肠内引流手术保持内分泌稳定，符合解剖生理，有临床应用的可行性。猪的门静脉回流＋肠内引流手术模型的成功建立为临床开展胰腺移植门、肠引流手术奠定基础。Objective To establish the model of pancreatoduodenal transplantation in pigs with enteric drainage （ED） and portal venous drainage （PVD）. Methods Forty hybrid landraces were randomized into the donor group and recipient group. Pancreatoduodenal allotransplantation was then performed. The donor pigs were perfused via abdominal aorta without clamping the portal venous outflow with UW solution at 80- 100 crnH20 after heparinization. Whole pancreatoduodenal graft was harvested with segments of abdominal aorta and portal vein and shaped under cold UW solution. Then the end-to-end anastomosis was performed with the donor iliac artery bifurcation Y graft to the recipient superior mesenteric arteries and celiac artery. Furthermore, type Ⅰ diabetes model was established by removal of the recipient pancreas. The venous anastomosis was reconstructed between the donor portal vein and the recipient superior mesenteric vein. Meanwhile, the end-to-side anastomosis was performed with the donor common iliac artery bifurcation Y graft to the recipient abdominal aorta and the side-to-side intestinal anastomosis was done between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. The levels of sugar, insulin and glucagons in blood were determined during the operation and 1, 3, 5 and 7 d after the operation. Results Twenty pigs in the recipient group received pancreatoduodenal allotransplantation. One died from complication of anesthesia. The successful rate was 95.6%. Operative complications occurred in 3 pigs, in which phlebothrombosis accounted for 4. 6%, duodenojejunal anastomotic leakage for 4. 6%. The blood level of sugar decreased and those of insulin and glucagons increased within 30 min and recovered on the 2nd d after removal of the pancreas. Rejection occurred on the 1st d and reached the worst level on the 7th d after transplantation without the changes in blood levels of insulin and glucagons and symptoms of rejection. Conclusions Pancreatoduodenal transplantation

关 键 词：移植 同种 胰腺 术式 动物模型 

分 类 号：R686[医药卫生—骨科学]