Failure of autotransplantation of the spleen in dogs: an anatomic, radionuclide imaging, and pathologic study

Although splenic autotransplantation is successful in mice and rats, with regeneration occurring in any location, no extensive study had been performed on dogs. We transplanted the spleen into subcutaneous and intraperitoneal locations on 40 dogs. Four to six months later, splenic scanning and reexploration was carried out. Spleens were removed, weighed, and microscopic sections were made. Months later, no uptake was present on scanning, weight was less than 6% of original weight, and little identifiable splenic tissue was present on microscopic sections. When 15 small sections were transplanted to the omentum in a "necklace" fashion, good uptake and preservation were seen after six months. The small amount of spleen transplanted by this method, however, makes this an unsatisfactory option. We conclude, therefore that our large-animal experiments do not provide a basis on which to recommend autotransplantation of the spleen in humans. Preservation of splenic tissue by splenorrhaphy is still the treatment of choice.     

Early clinical experience with postoperative monitoring of a patient after laparoscopic splenectomy combined with spleen autotransplantation. A case report

We performed splenectomy combined with spleen autotransplantation after blunt abdominal trauma by minimally invasive technique at the County Teaching Hospital in Kecskemét. In case of advanced post traumatic spleen injury, spleen autotransplantation (Furka's spleen chips) is a well-known method to try to avoid postsplenectomy syndrome. During the operation, when in situ preservation of the spleen is not possible, chips of spleen tissue are transplanted into the omentum. Function of the transplanted spleen tissue was monitored by scintigraphy. We describe two different types of spleen scintigraphy to check the viability of spleen chips.     

43例外伤性脾破裂的治疗体会

目的总结外伤性破裂的治疗方法与经验。方法对我院1995～2004年12月外伤性脾破裂43例患者资料进行回顾性分析,其中40例患者进行剖腹探查,术中行脾修补术13例,脾部分切除术9例,全脾切除13例,脾切除加自体脾脏移植术5例,3例在严密观察下行保守治疗。结果2例脾破裂患者术后因合并颅脑损伤和严重复合伤死亡,41例患者痊愈出院。结论遵循“抢救生命第一,保留脾脏第二”的原则,根据脾损伤伤情及病人的全身情况去选择手术方式,分别施行脾修补术,部分脾切除术,全脾切除术,全脾切除术加自体脾片移植术。如果伤情允许术中尽量保留器官,对不能保脾的伤者可行脾片移植术以保术后病人有良好的免疫功能。     

Experimental studies on splenic autotransplantation in rats

To determine if splenic implants in the body regain vascularization and grow, and to determine the effects of any interaction between implant and remnant on growth of these spleen fragments, we conducted experiments on rats. 1) Spleen fragments were implanted in the omentum (20 cases), in the subcutaneous space (20 cases), or in the liver (10 cases), and the weight of splenic portions and its histological findings were observed 12 and 24 weeks after operation. The best splenic growth was observed in the group of implant in the omentum. 2) Total, 4/5, 2/3, 1/3 and 1/5 spleen were implanted in the omentum and the weight of implants were measured 6 weeks after the operation. The rate of growth of implanted spleen was the highest in the group of 1/5 and was the lowest in the group of whole spleen. 3) Two groups of rats underwent 1/3 splenectomy, and the 1/3 spleen portions was implanted in the omentum. One group had the remaining 2/3 spleen removed, the other group had the remaining 2/3 spleen left in place. In group at 6, 12 and 24 weeks postoperatively the splenic portions was weighed. The implants regenerate with time in rats of both groups. The rate of weight-gain was, however, slow in the group with 2/3 spleen and there was no regeneration on the remaining 2/3 spleen.     

自体脾腹膜后移植在创伤性脾破裂中的临床应用

目的探讨自体脾组织移植在治疗创伤性脾破裂的应用.方法对本组于2000年1月至2005年4月22例脾破裂行全脾切除后,再行自体脾组织腹膜后移植术.通过检测外周血IgM、IgA、IgG水平和B超,CT、99mTc扫描来观察移植脾片成活和吞噬功能恢复情况.结果术后随访均显示移植脾存活良好,脾功能满意.结论自体脾组织移植可作为严重脾外伤全脾切除术后保留脾功能的一个重要有效手段.     

脾脏捆扎术的实验研究

目的 探讨脾拥扎术在保留脾脏手术中的应用.方法 取成年杂种犬16只,随机分为2组,分别于脾脏的上、中、下极模拟脾脏损伤Ⅱ、Ⅰ、Ⅲ级.实验组均采用脾脏捆扎术,对照组分别采用结节缝合加大网膜充填,结节缝合加明胶海绵及部分脾脏切除术.分别观察手术时间,失血量的多少,脾脏的近期和远期形态改变以及脾脏功能变化.结果 脾脏上极损伤实验组失血量明显少于对照组(21±6/32±17;P＜0.05),脾脏F极损伤对照组脾脏形态改变和功能变化明显高于实验组(8/1,P＜0.05;8/2;P＜0.05).结论 脾捆扎术是一种非常有效的保脾手术方法,选择性治疗Ⅰ～Ⅲ级外伤性脾破裂远期效果好.安全简便,能最大限度保留脾脏功能.     

自体脾移植临床研究

目的探讨自体脾组织移植在严重脾损伤患者的应用及临床意义。方法46例严重脾损伤患者行脾切除术,其中26例行自体脾移植为治疗组,20例为对照组。观察血清免疫球蛋白的含量、NK细胞活性和T淋巴细胞转换率的变化。结果血清免疫球蛋白的含量两组lgG、lgA和脾移植lgM术前与术后相比较无显著差异(P>0.05)。两组NK细胞活性和T淋巴细胞转化率比较有明显差异(P<0.01)。结论自体脾移植术后患者机体免疫功能能维持在正常水平,是保留脾脏功能的有效措施之一。     

腹膜后自体脾移植治疗外伤性脾破裂的前瞻性研究

目的 探讨腹膜后自体脾移植在严重脾外伤保脾手术中应用的可行性及价值。方法 采用前瞻性病例对照研究,将66例严重脾外伤病人分为腹膜后自体脾移植组例、大网膜自体脾移植组,其中腹膜后自体脾移植组32例,大网膜自体脾移植组34例。观察术后一般情况,术后1天～ 12个月血常规,血IgA、IgM、IgG、C3、Tuftsin水平变化。结果 腹膜后自体脾移植组手术时间短于大网膜自体脾移植组（P<0.05）,术后其它一般情况变化、术后1天～ 12个月血IgA、IgM、IgG、C3、Tuftsin水平两组无统计学差异（P> 0.05）。结论 腹膜后自体带蒂脾移植术能够保留脾脏的部分免疫功能,且手术操作简便,在临床上推广应用是可行的。     

Partial splenectomy with the CO2 laser: an alternative technique

Because total splenectomy has been shown to affect immunocompetence in children, partial splenectomy is advocated as an alternative to total splenectomy in traumatic injury as well as in treatment of benign cysts. Present techniques include elaborate hemostatic techniques and extensive suture repair which has led to the development of massive abdominal adhesions. We have investigated CO2 laser sealing of splenic wounds to obviate the need for extensive repair and to minimize intraabdominal reaction. Five dogs underwent partial splenectomy with a scalpel. Hemostasis was obtained with CO2 laser coagulation; a defocused laser beam at 8 W (power density 30-50 W/cm2). After 3 weeks, the laser sealed splenic tissue was amputated and, on this occasion, hemostasis was obtained using a standard suture technique of Teflon pledget-bolstered chromic sutures. Three weeks later the dogs were explored and the sutured splenic tissue was removed. Gross findings on the first exploration demonstrated no signs of hemorrhage and minimal adhesions of the laser sealed spleens. In contrast, exploration after suture repair revealed dense adhesions containing the spleen, omentum, mesentery, and small and large bowel. Microscopic examination of the laser sealed spleen showed a zone of injury only 2-3-mm thick. Excellent hemostasis of the cut surface of the spleen can be accomplished using the CO2 laser. In addition, the minimal depth of injury and the absence of foreign material in the peritoneal cavity make this an attractive alternative to conventional methods.     

Hematological, hemorheological, immunological, and morphological studies of spleen autotransplantation in mice: preliminary results

Using a spleen autotransplantation model, we conducted hematological, hemorheological, immunological, and morphological studies in mice 6 weeks after splenectomy. Sixty male and female A/J inbred mice were equally divided into 3 groups: 1) SE group, splenectomy was performed; 2) AU group, spleen chips were autotransplanted into the omentum without vascular anastomosis following splenectomy; and 3) C group (controls), no intervention in these mice. At postoperative week 6, the following studies were performed: 1) measurement of hematological parameters; 2) hemorheological studies, including relative cell transit time (RCTT) and fibrinogen levels; and 3) activity of peripheral phagocytes, measured by zymozan-induced chemiluminescence, which was calculated in stimulation index values (SI). In addition, histological investigations of autotransplants were conducted. Erythrocyte mean cell volume and platelet counts, RCTT, fibrinogen levels, and activity of phagocytes were significantly higher in the SE group, compared to those in the C group. In the AU group, these parameters were similar to those in the C group. Morphologically, the transplanted spleen showed normal histology. These data indicate that the transplanted spleens restored their function. We conclude that spleen autotransplantation reserves the normal morphology of spleen and restores most of the spleen's hematological, hemorheological, and immunological functions. Both SI index and erythrocyte deformability can be an informative detection of decreasing splenic function. These data suggest that spleen autotransplantation may provide a useful tool to prevent complications following splenectomy in a clinical setting.     

Splenic phagocytic function after partial splenectomy and splenic autotransplantation

We investigated splenic reticuloendothelial activity after splenic preservation procedures to determine their effect upon the phagocytic function of the spleen. We performed the following procedures in Sprague-Dawley rats: sham laparotomy, total splenectomy, hemisplenectomy, subtotal splenectomy, or total splenectomy with intraperitoneal splenic autotransplantation. At nine weeks after operation, phagocytic function of the spleen was determined by measuring radiocolloid uptake. Mean (+/- SEM) splenic phagocytic indices for sham laparotomy (41.2 +/- 2.9), hemisplenectomy (44 +/- 2.9), and subtotal splenectomy (43.2 +/- 5.2) were similar; however, the phagocytic index was reduced markedly after autotransplantation (15.8 +/- 2.2). These data demonstrate that the phagocytic function of the spleen after hemisplenectomy and subtotal splenectomy correlates highly with the weight of the splenic remnant; however, phagocytic function after autotransplantation remains reduced even after accounting for differences in splenic weight.     

创伤性脾破裂的诊治:附184例报告

目的　总结创伤性脾破裂的诊治经验 ,以提高脾破裂的诊治水平。方法　回顾性分析近9年来收治的 184例创伤性脾破裂的诊断和治疗。结果　根据外伤史、体查、诊断性腹穿和B超、CT等检查 ,诊断正确率为 96.7%。非手术治疗 3 4例 ( 18.5 % ) ,均保守成功 ;手术治疗 15 0例 ,除 2例术中死亡外 ,余均一期手术成功 ,痊愈出院。结论　外伤病史的详细询问和体查 ,多部位反复的腹腔穿刺和必要的辅助检查是提高脾破裂诊断率的关键。创伤性脾破裂在确保伤者生命安全的前提下 ,应尽可能保留脾脏 ,尤其是儿童。脾修补加或不加脾动脉结扎是保脾治疗中较为简单、安全、有效的方法。     

Splenic function after splenectomy for trauma. Role of autotransplantation and splenosis

Follow-up of patients treated for severe trauma to the spleen, with autotransplantation (20 cases) or splenectomy (21 cases) included hepatic and splenic scintigraphy, intracutaneous skin testing with seven recall antigens and hematologic studies (red and white blood count, Howell-Jolly bodies, erythrocyte morphology, immunoglobulins, complements). In all reimplantation cases splenic tissue was scintigraphically demonstrated. After removal of the spleen due to severe traumatic ruptures the incidence of splenosis was 66%. Good clearance function in all reimplantation and splenosis cases was demonstrated by Howell-Jolly bodies and erythrocyte morphology. Autotransplantation of splenic tissue is a simple and safe procedure, without serious complications. As yet, however, there is no proof that it provides adequate resistance to infections. Reimplantation, therefore, should be performed only if spleen-preserving procedures are not feasible.     

The argon beam coagulator provides rapid hemostasis of experimental hepatic and splenic hemorrhage in anticoagulated dogs

The argon beam coagulator (ABC) delivers radiofrequency electrical energy to tissue across a jet of argon gas, providing noncontact, monopolar, electrothermal hemostasis. This study compared the efficacy of the ABC with conventional techniques for control of traumatic hepatic and splenic hemorrhage. Standardized lacerations were made to the liver and spleen of 6 heparinized dogs. Control of bleeding was attempted with the ABC (150 W), the Nd:YAG laser (90 W, noncontact), horizontal mattress suture, microcrystalline collagen, and regenerated cellulose. If bleeding had not been controlled within 3 minutes, coagulation was attempted with the ABC in order to prevent exsanguination. Tissue from both the liver and spleen was assessed histologically for damage induced by the ABC. Delayed injury and early healing after ABC coagulation was studied in six additional dogs killed 1 and 3 weeks postoperatively. The ABC stopped bleeding from 25/25 hepatic lacerations in 48 +/- 8 seconds (mean +/- SEM) and from 18/18 splenic lacerations in 28 +/- 3 seconds. The Nd:YAG laser, mattress sutures, and topical hemostatic agents failed to control bleeding in 14 of 15 applications after 3 minutes. The ABC successfully salvaged all failures in less than 1 minute. The depth of splenic and hepatic thermal injury with the ABC ranged from 2 to 7 mm and was proportional to the duration of application. Postoperatively wound healing progressed normally without bleeding or infection at the coagulation site. The ABC appears to be a excellent instrument for achieving hemostasis in solid organ injury, and may be especially valuable in managing patients with coagulation deficits.     

Hepatocellular transplantation for experimental ischemic acute liver failure in dogs

Recovery from acute liver failure is possible if metabolic support can be provided during the period of exogenous liver regeneration. The ability of transplanted dispersed autologous hepatocytes to alter the course of experimental ischemic acute liver failure in dogs was tested. Liver failure was induced by occlusion of blood flow in the proximal portal vein and hepatic artery(s) 48 hr after creation of a side to side portacaval shunt and immediately after a left lateral hepatic lobectomy. Dogs in Group 1 had ischemic injury with no treatment. Dogs in Group II received intrasplenic autotransplants of hepatocytes (26 ± 4x × 10⁸ intact cells) after the ischemic period. Cells for transplantation were prepared from the excised lobe during the period of liver ischemia. Dogs in Group III received intrasplenic transplants of autologous hepatocytes (26 = 3 × 10⁸ intact cells) after liver ischemia and after ligation of the main splenic artery. Serum bilirubin, serum glutamic oxalocetic transaminase, lactate dehydrogenase, and alkaline phosphatase were measured before and serially after ischemia, and showed that the degree of liver injury in all three groups was similar, although survival in Group III was better. Only 20% of nontransplanted animals (Group I) survived 10 days. Liver histology in animals that died showed hemorrhagic necrosis situation around the terminal hepatic central veins. Transplantation did not improve survival in dogs with arterialized spleens and histological examination of dogs that died showed pulmonary infarcts and additional liver injury from embolization of hepatocytes. In contrast, 70% of the animals undergoing splenic artery ligation before intrasplenic transplantation of hepatocytes were alive at 10 days. Ligation of the splenic artery reduced the tendency for hepatocytes to escape into the splenic vein and the spleen remained viable due to collateral circulation. On histological examination, hepatocytes were readily identified in the splenic parenchyma at 24 hr. 2 and 4 weeks after transplantation. In conclusion, intrasplenic hepatocytes provide sufficient metabolic support for dogs to recover from otherwise lethal ischemically induced, acute liver failure.     

Immunologic function against infection in splenic autotransplanted mice

The increasing recognition of the danger of overwhelming postsplenectomy infection (OPSI) has led surgeons to attempt to maintain splenic function after spleen injury. One technique they use when splenorrhapy or partial splenectomy are not feasible is the deliberate autotransplantation of splenic tissue. But the amount of splenic tissue necessary to prevent OPSI remains controversial, and opinions differ about the importance of the location and size of the splenic fragments implanted. The mice were divided into five groups, I. splenectomy, II. splenectomy +30% of the spleen implanted intraperitoneal site, III. splenectomy +50% implanted intraperitoneally, IV. splenectomy +50% implanted subcutaneously and V. Sham operation. This study assessed the blood flow of the splenic tissue, increasing weight of splenic mass, histology, the serum level of the immunoglobulins (IgG, IgA, and IgM), pneumococcal antibody titers after vaccination, and survival after intravenous pneumococcal challenge. This study demonstrated that intraperitoneal transplantation showed better regeneration and afforded better protection from OPSI than subcutaneous transplantation. And 30 to 50 percent of the whole splenic tissue mass protected against experimental pneumococcal sepsis. The splenic autotransplants developed in volume and blood supply after 8 weeks, and immunologic function against infection recovered at the same time.     

Pancreatic transplantation. Absence of diabetes in dogs after total pancreatectomy and intrasplenic autotransplantation of pancreatic tissue.

Two simple, rapid, and reproducible techniques of pancreatic tissue preparation produced favorable results after just part of the gland was autotransplanted in totally pancreatectomized animals. It is probable that the short and less traumatic treatment in vitro was responsible for the sufficient yield of viable islets. Moreover, the results show convincingly that the complete separation of endocrine from exocrine pancreas is not mandatory to insure adequate endocrine secretion. The spleen, an organ of no vital importance having a rich blood supply and belonging to the portal circulation, was a very suitable experimental implantation site, which permitted thorough evaluation of the tissue preparation techniques. These favorable results were not conditioned by the splenic tissue itself, because similar results have been obtained in dogs when the tissues were implanted into the liver via the portal vein.     

Experimental study on function of regenerated splenic tissue after splenic autotransplantation

To prevent postsplenectomy overwhelming sepsis, splenic autotransplantation has been clinically attempted. However, function of regenerated splenic tissue after splenic autotransplantation has not been completely understood. Changes in weigh of regenerated splenic tissue, splenic blood flow, splenic immune responses and phagocytic function were studied for one year after splenic autotransplantation using Sprague-Dawley rats. At one year after autotransplantation, the weight of regenerated splenic tissue was increased to 80% of the originally implanted spleen and the blood flow was increased to 80% of the control spleen. The counts of lymphocytes and macrophages in the regenerated splenic tissue were significantly low at eight weeks after transplantation, however lymphocytes was increased to 58.8% and macrophages was increased to 29.5% of the control spleen at 16 weeks after transplantation. The blast formation of splenic lymphocytes was lower at the early stage after transplantation, thereafter, it was increased at the later time after transplantation. Microangiography of the regenerated spleen showed new capillaries around the implanted tissue 2 weeks after transplantation. These results suggested that the transplanted splenic tissue was regenerated to the similar structure to normal spleen and immunological function was recovered close to the normal splenic tissue.     

脾损伤的脾保留手术——10年经验总结

目的：本文旨在阐明脾损伤的外科处理原则，结合我们10年来保脾手术的经验探讨脾保留手术的适应证、手术技术及疗效。方法：回顾性分析1989年5月至1999年5月间收治的166例脾损伤行保留性脾手术病例。结果：本组病例无死亡，保脾成功108例（65．1％）。58例（34．9％）被迫行脾切除，40例（56％）同时行脾组织自体移植。所有脾保留性手术均无并发症发生。109例术后平均随访13．5个月，脾功能良好，无感染并发症。结论：保留性脾手术在选择适当的病例中可安全施行。成功实施取决于三因素：格守脾损伤处理的一般原则，依脾损伤类型及病人状况选择恰当术式，掌握保脾术式的技术要点。     

外伤性脾破裂的治疗：附208例报告

目的:探讨外伤性脾破裂治疗中保脾技术的临床应用。方法:回顾性分析近10余年收治的208例脾外伤患者的临床资料。其中非手术治疗20例;采用保脾手术治疗88例,包括 20例单纯脾修补,48例施以脾动脉结扎和/或脾部分切除和/或脾修补术，20例脾切除术后自体脾移植;100例脾门及附脾多处破裂者行脾切除术。结果:108例保脾患者经手术或非手术治疗后, 其IgM，CD3+ 远高于切脾组，差异有显著性( P<0.01); CD8+和CD4+显著高于切脾组（P<0.05），痘痕红细胞百分率低于切脾组（P<0.01）。CT， B超，99锝核素显像等证实保脾组1个月后脾结构恢复正常，裂口创面完全愈合。结论:大部分外伤性脾破裂患者可采用保留脾治疗,术后脾结构和功能均可恢复正常。