猪同种异体胰十二指肠移植门静脉回流肠内引流模型的实验研究  

Study of Whole Pancreatoduodenal Allotransplantation Model with Enteric Drainage and Portal Venous Drainage in Pigs

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

机构地区：[1]四川大学华西医院普通外科,成都610041

出　　处：《中国普外基础与临床杂志》2007年第2期171-176,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家教育部博士点基金资助课题(编号:20030610071);CMB资金赞助(编号:82412)~~

摘　　要：目的研究猪胰十二指肠移植治疗实验性Ⅰ型糖尿病的可行性及其意义。方法选四川当地杂种长白猪46头（体重25-32kg），分为供、受体2组（n=23），进行同种异体胰十二指肠移植手术。观察术后手术并发症，术前、术中及术后1、3、5及7d检测血糖、胰岛素及胰高血糖素水平，观察移植物存活及急性排斥反应情况。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95．7％。发生手术并发症2例，其中静脉血栓形成1例（4．5％），十二指肠空肠吻合口漏1例（4．5％）。在切除胰腺30min内即可见血糖升高，术后第3d开始恢复至术前水平。胰岛素和胰高血糖素在切除胰腺30min内开始下降，术后第3d开始恢复到术前水平。手术后第1d开始出现排斥反应，并逐渐加重，第9d达到高峰，但未出现血糖、胰岛素及胰高血糖素水平变化和排斥反应的临床症状。结论猪胰十二指肠移植治疗Ⅰ型糖尿病效果确实、可靠，移植术后急性排斥反应是影响术后功能的主要因素。Objective To establish the model of pancreatoduodenal allotransplantation in pigs with enteric drainage （ED） and portal venous drainage （PVD）. Methods Forty-six hybrid landraces were divided into two groups （donor and recipient groups） randomly, for pancreatoduodenal allotransplantation. Donors were perfused via abdomial aorta without clamping the portal venous outflow with UW solution after heparinization. Whole pancreatoduodenal graft was harvested with segments of abdomial 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 diabete model was made 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 bi furcation ＂Y＂ graft to the recipient abdomial aorta and the side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum. External jugular vein was intubated for transfusion. The levels of blood glucose, insulin and glucagon in blood were measured before and during the operation and 1, 3, 5, 7 d after operation. Results Twenty-three cases of pancreatoduodenal allotranplantations were performed on pigs. One died from complication of anesthesia. Success rate of operation was 95.7 %. Complications of operation happened in 2 cases in which one was phlebothrombosis, incidence 4.5% and the other was duodenojejunal anastomotic leak, incidence 4.5 %. The level of blood glucose increased within 30 min and recovered on the 2nd day after removal of pancreas. The levels of insulin and glucagon decreased within 30 min and recovered on the 2nd day after removal of pancreas. Rejection curred at the 1st day and reached the worst level on the 9th day after transplantation without the change o

关 键 词：胰腺移植 动物模型 排斥反应 

分 类 号：R656[医药卫生—外科学]