两种外引流方式的猪同种异体胰十二指肠移植对比研究

发布时间：2018-05-04 12:36

本文选题：胰十二指肠移植 + 空肠引流　；参考：《重庆医科大学学报》2015年03期

【摘要】：目的:建立经空肠外引流及经胃外引流的猪同种异体胰十二指肠移植动物模型,探索一种并发症少、外引流方式更符合生理要求的手术方式。方法:选择20~30 kg的封闭群白猪共24只,随机分为空肠引流(enteric drainage,ED)组、胃引流(stomachic drainage,SD)组,每组12只,组间再随机分为供、受体2组,每组6只,进行经腔静脉内外流经空肠外引流及经腔静脉内引流经胃外引流胰十二指肠移植。记录手术时间,观察受体猪术前24 h、麻醉开始前、胰腺切除后30 min、移植成功后动静脉开放时、动静脉开放后30 min、术后12 h、术后每天的血糖、胰岛素、胰高血糖素、血淀粉酶变化,观察术后并发症、移植物存活情况。结果:手术成功率为100%,SD组手术时间比ED组手术时间略长,但差异无统计学意义(P=0.551)。ED组术后发生移植物静脉血栓形成、胰瘘各1例,SD组术后出现吻合口瘘1例。2组间各时段血糖、胰岛素、血清淀粉酶比较无明显统计学差异(P=0.581、P=0.831、P=0.983);组间胰高血糖素差异有统计学意义(P=0.024 4),但结果可能为假阳性。组内比较差异有统计学意义(P=0.000、P=0.000、P=0.000、P=0.000)。结论:ED、SD 2种外引流术式的同种异体猪胰十二指肠移植手术操作可行,成功地建立了经空肠外引流及经胃外引流的猪同种异体胰十二指肠移植动物模型。SD有便于术后取病理活检来判断免疫排斥反应的优势,但2种术式在并发症、免疫排斥、病人生存率、移植物存活率等方面仍需要大量临床研究。
[Abstract]:Objective: to establish an animal model of porcine pancreaticoduodenal allograft transplantation with external jejunal drainage and gastric drainage, and to explore a surgical method with less complications and more physiological requirements for external drainage. Methods: a total of 24 pigs were randomly divided into two groups: enteric drainage EDgroup and stomachic drainage group (n = 12 in each group). Each group was randomly divided into two groups: recipient group (n = 6) and recipient group (n = 6). The pancreaticoduodenal transplantation was performed through internal and external drainage of vena cava through jejunum and through internal drainage of vena cava via extragastric drainage of pancreaticoduodenum. The time of operation was recorded 24 hours before operation, before anesthesia, 30 minutes after pancreatectomy, 30 minutes after successful transplantation, 30 minutes after arteriovenous opening, 12 hours after operation, daily blood glucose, insulin and glucagon were observed every day after operation. The changes of serum amylase, postoperative complications and graft survival were observed. Results: the successful rate of operation in SD group was a little longer than that in Ed group, but there was no significant difference between two groups. There was no significant difference in insulin and serum amylase between two groups (P < 0. 581P = 0. 581P = 0. 983, P = 0. 024 4, P = 0. 024 4, P = 0. 024 4), but the results might be false positive. The difference between the two groups was statistically significant (P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000, P = 0.000). Conclusion it is feasible to perform two kinds of extravasation and extravasation of two kinds of extravasation methods for the transplantation of porcine pancreaticoduodenum allografts. The animal model of porcine pancreaticoduodenal allograft transplantation with external jejunal drainage and external gastric drainage was successfully established. SD has the advantage of obtaining pathological biopsy after operation to judge the immune rejection, but the two kinds of operation are in complications and immune rejection. Patient survival and graft survival still require a great deal of clinical research.
【作者单位】：重庆医科大学附属第一医院内分泌乳腺外科;
【基金】：重庆市科技攻关计划资助项目(编号:cstc2012gg-yyjs10041) 重庆市渝中区科技计划资助项目(编号:20130124)
【分类号】：R657.5

【参考文献】