两种外引流方式的猪同种异体胰十二指肠移植对比研究

Comparison on two types of external drainage in pig pancreaticoduodenal transplantation

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 two types of animal model of pancreatoduodenal transplantation in pigs with enteric drainage（ED） and stomachic drainage（SD），to explore a more physiological operation method with fewer complications. Methods：Twenty-four close group white pigs were divided into ED group and SD group randomly；the pigs in each group were randomly subdivided into donor and receptor groups for pancreatoduodenal transplantation with ED or SD. The levels of blood glucose，insulin，glucagon and amylase were measured at the following time：24 h before operation，before the start of anesthesia，30 min after the pancreas removed，after the reperfusion，30 min and 12 h after the pancreatoduodenal transplantation. Postoperative complications and graft function were observed. Results：The success rate of surgery was 100%. The operation time was slightly longer in SD group than in ED group，but without sta－tistically significances（P=0.551）. Complications occurred in 2 cases in ED group：one was graft thrombosis and the other one was pancreatic fistula. One case of anastomotic fistula occurred in SD group. No significant difference was found between the two groups in blood glucose，insulin and serum amylase in each period. The levels of glucagon between the two groups were statistically different（P=0.024 4），but the result may be false positive. The differences between groups were statistically significant. Conclusion：Pancreato－duodenal transplantation in pigs with ED and SD is feasible. SD can facilitate postoperative pathological biopsy to determine the im－mune rejection. Numbers of clinical studies are needed to deter－mine the complications，immune rejection，survival rate，graft survival of the two operative methods.