猪胰肾联合移植门静脉回流和体静脉回流术式对急性排斥反应的影响  

Impact of portal versus systemic venous drainage on acute rejection of simultaneous pancreas-kidney transplantation in pigs

作　　者：唐勇[1] 李建水[2] 李幼平[3] 张肇达[4] 何满西 韩方海[6] 李永胜[3] 董高宏[7] 李冈栉[8] 

机构地区：[1]天津医科大学附属肿瘤医院胰腺科,300060 [2]四川川北医学院普外科 [3]四川大学华西医院移植工程和科学实验室 [4]四川大学华西医院普外科 [5]四川雅安市中心医院普外科 [6]中山大学附属第一医院胃肠外科 [7]暨南大学附属第一医院器官移植中心 [8]四川遂宁市人民医院普外科

出　　处：《中华移植杂志（电子版）》2009年第1期29-32,共4页Chinese Journal of Transplantation(Electronic Edition)

基　　金：美国纽约中华医学基金会资助项目(CMB82-412)

摘　　要：目的比较胰肾联合移植门静脉回流(PE)和体静脉回流(SE)两种术式对移植物急性排斥反应的影响。方法48例无亲缘当地杂交第1代长白猪,随机分成PE组(24只)和SE组(24只),每组内行交叉配血,相合者组成供受猪。切除受猪胰腺制成1型糖尿病模型,同时切除右肾。PE组门静脉与受猪肠系膜上静脉或门静脉行端侧吻合,SE组门静脉与受猪肝下下腔静脉吻合,外分泌均采用肠道引流。术后1、3、5、7 d监测血糖和移植肾尿液肌酐水平;术后3、7d开腹取移植胰和肾组织行病理学检查,参照Nakhleh和Banff标准对移植胰腺和肾进行排斥反应评分。结果PE组和SE组各行12例移植手术,两组移植物冷缺血时间差异无统计学意义[PE组为(231.25±19.86)min;SE组为(234.60±15.80)min,P>0.05]。两组术后1、3、5、7 d血糖和移植肾尿液肌酐水平差异无统计学意义(P>0.05)。SE组较PE组移植胰腺和肾急性排斥反应发生早且重,两组急性排斥反应病理评分差异有统计学意义(P<0.05)。结论猪胰肾联合移植内分泌PE与SE相比,可减轻和延缓急性排斥反应。Objective To compare the influence of portal vein and systemic vein drainage on acute rejection after simultaneous pancreas-kidney （SPK） transplantation in pigs. Methods Forty- eight non-related, first hybrid landraces were randomized into portal-enteric drainage （PE） and systemicenteric drainage （SE） groups, 24 pigs in each. The donors and recipients were matched according to blood type cross-match results in each group. Type I diabetes mellitus was induced by total pancreatectomy and the right-side nephrectomy was performed in the recipient. The portal vein was anastomed to superior mesenterie vein of the recipient in the PE group and to the inferior hepatic vena of the recipient in the SE group. Duodenojejunostomy was performed to manage the exocrine in both groups. The levels of fasting blood glucose （FBG） and urine creatinine （UCr） of the graft kidney were measured on the 1st, 3rd, 5th, 7th day after transplantation. Graft tissue specimens were obtained with open laparotomy on the 3rd and 7th posttransplant day and acute rejection was scored according to Nakhleh and Banff standards. Results Twelve SPKs were performed in each group. The mean cold ischemia time of the 2 groups was （231.25± 19.86）min vs （234.60 ± 15.30）min （P 〉 0.05）. FBG and UCr had no statistic difference between the 2 groups on the 1st, 3rd, 5th, 7th postoperative day. Compared to the SE group, acute rejection in the PE group occurred later and slighter, with significant difference in pathological scores （ P 〈0.05）. Conclusion Portal vein drainage, compared with systemic vein drainage, could ameliorate and delay rejection in pig pancreas-kidney transplantation in pigs.

关 键 词：胰肾联合移植 静脉回流 术式 急性排斥反应 猪 

分 类 号：R617[医药卫生—外科学]