Establishment of simultaneous pancreas and kidney transplantation （SPK） model with cuff technique and portal venous drainage in rats

To establish a simultaneous pancreas and kidney transplantation （SPK） model in the rat. Methods： SD rats served as donors and recipients. The donor portal vein and the recipient superior mesenteric vein were anastomosed and the donor renal veins and recipient renal veins were anastomosed by cuff method. Arterial reconstruction was carried out by end to side anastomosis of the donor abdominal aorta to the recipient abdominal aorta. Enteric drainage was performed by side to side anastomosis between donors＇ duodenum and recipients＇ jejunum. The donor ureter -bladder valve was anastomosed to the bladder of recipients. Results： Out of 30 cases of SPK transplantation, 24 had normal serum glucose and serum creatinine after operation. The successful rate was 80 %. Conclusion： This model of SPK in rats is stable and reliable, which could be applied for further scientific research.     

胰-十二指肠移植肠内引流的新型大动物模型

目的 建立稳定的、符合生理的门静脉回流、空肠内引流术式猪全胰十二指肠移植模型。方法 20头四川本地杂种猪分为供、受体2组（n=10）。采用UW液低温灌注的方法,整块切取供体全胰十二指肠,保留腹主动脉段和门静脉。完整切除受体胰腺而建立Ⅰ型糖尿病模型。修整后的胰腺十二指肠移植物用腹主动脉膈下端与受体腹主动脉段端．侧吻合;门静脉与受体肠系膜上静脉端-侧吻合;十二指肠与受体空肠侧-侧吻合。结果 实验共完成猪全胰十二指肠移植手术10例。1例移植胰腺术后第六天血栓形成。平均生存14．6d。结论 此新型猪全胰十二指肠移植门静脉回流、空肠内引流术式大动物模型稳定、可靠。     

大鼠胰腺移植模型的建立

目的 建立大鼠胰腺移植模型。方法 采用经膀胱引流全胰腺十二指肠６主式,带腹腔动脉和肠系膜上动脉的腹主动脉段与受体腹主动脉端侧吻合,供体门静脉以体下腔静脉端侧吻合,胰腺外分泌经膀胱引流。结果 １８只大鼠移植成功,早期胰腺血供良好。结论 此处模型方法是可行的。     

猪全胰十二指肠移植空肠引流及门静脉回流模型的建立

目的　建立猪的全胰十二指肠移植空肠内引流 ,门静脉回流模型。方法　 40头杂种猪分为供体组和受体组 ,对供体组 ( n=2 0 )进行 U W液低温灌注 ,切取全胰十二指肠以及部分腹主动脉和门静脉。修剪移植胰腺和十二指肠 ,U W液保存移植物的肠系膜上动脉开口和腹腔动脉开口分别与供体的髂内外动脉端 -端吻合呈“Y”形。切除受体组胰腺建成 型糖尿病模型 ,移植物的门静脉与受体的肠系膜上静脉吻合 ,移植物“Y”形的髂总动脉与受体腹主动脉端侧吻合。十二指肠与空肠侧侧吻合。结果　本实验完成全胰十二指肠移植 2 0例 ,胰腺移植手术中因麻醉过深呼吸抑制死亡 1例 ,2例手术后移植胰腺形成血栓、梗死。 17例手术后 2 4h外周血检测血糖正常 ,移植胰腺存活时间平均 18.6± 2 .6d。结论　成功地建立了猪全胰十二指肠移植空肠引流及门静脉回流的模型     

套管法大鼠异位脾移植模型的建立

目的　探索一种简单方法建立大鼠异位脾移植模型的可行性。方法　Wistar大鼠 60只 ,健康雄性 ,随机平均分成供体组和受体组。切取供脾时 ,保留腹腔干和门静脉。游离并保留受体大鼠的左肾血管 ,切除左肾。用2 2G聚乙烯管做内置管 ,将供体腹腔干与受体肾动脉连接、固定。用 1 7G聚乙烯管袖套法将供体门静脉与受体肾静脉连接、固定 ,重建移植脾血供。术后观察并评估大鼠生存状况及移植脾形态学变化。结果　 30次移植手术全部成功 ,手术时间 55min± 5min。多数大鼠生存良好 ,本组 4例发生并发症死亡 (1例死于血栓 ,2例死于胰腺炎 ,1例死于腹腔感染 )。移植脾术后早期肿胀 ,然后逐渐缩小 ,最后形成包裹脾 ,被受体吸收。光镜下 ,1周内移植脾动脉周围淋巴鞘逐渐增大 ,红髓区细胞数量逐渐增加。至术后 1 4日 ,坏死灶已遍布移植脾。结论　该模型手术时间短 ,不阻断体循环 ,无须血管吻合技术 ,手术成功率高 (1 0 0 % ) ,可用于脾移植相关的实验研究。     

原位肝移植肝动脉和门静脉的重建

目的：总结同种异体原位肝移植术中肝动脉和门静脉吻合的经验。方法：回顾性分析9例原住肝移植术中影响肝动脉和门静脉吻合的因素和处理技巧。结果：5例行供、受者肝固有动脉端端吻合，2例供者肝总动脉与受者肝固有动脉吻合，2例供者肝总动脉与受者脾动脉吻合；8例采用门静脉端端吻合，1例因受者门静脉主干长段闭塞，取栓无法再通，将供肝门静脉与受省下腔静脉吻合。术后彩色多普勒超声监测显示动脉和门静脉血流通畅，均未发现有血栓形成或狭窄，现存活6例。结论：合理选择吻合用血管是避免术后发生血栓形成和狭窄的关键。     

大鼠胰十二指肠移植模型制作的手术技巧

目的：探索建立大鼠胰腺移植模型的手术技巧。方法：采用经肠道引流全胰十二指肠移植术式；带腹腔动脉和肠系膜上动脉的供者腹主动脉与受者腹主动脉端侧吻合，供者门静脉与受者左肾静脉袖套法吻合，供者十二指肠与受者十二指肠端侧吻合。结果：9例次手术中51例次手术成功，术后移植胰腺具有内分泌功能。结论：这种胰腺移植模型制作切实可行，其成功的关键在于预防和治疗血管并发症。     

大鼠胰十二指肠移植模型的建立

目的建立大鼠胰腺移植模型。方法采用经肠道引流全胰十二指肠移植术式；带腹腔动脉和肠系膜上动脉的腹主动脉管与受体腹主动脉端侧吻合，供体门静脉与受体左肾静脉袖套法吻合，供体十二指肠与受体十二指肠端侧吻合。结果89只大鼠手术中51例手术成功，术后移植胰腺具有内分泌功能。结论这种胰腺移植模型制作方法切实可行。     

环孢霉素和供体脾细胞门静脉接种延长小鼠心脏移植存活

OBJECTIVE: To investigate the effect of portal venous inoculation of donor splenocytes combined with cyclosporin A (CsA) administration on cardiac allograft survival in mice. METHODS: Heterotopic cardiac transplantation between fully allogenic NIH/q and BALB/C strain mice was performed. A modified procedure of neonatal heart-in-ear transplantation, as originally described by Fulmer et al, was adopted. We prepared donor splenocytes from NIH/q or third-party C57BL/6 spleens for BALB/C recipients, which were injected preoperatively via the recipient portal vein or the systemic vein 1 week before the heart-in-ear transplantation. The recipients were subsequently treated with a short course of the immunosuppressive agent, CsA (4 mg/kg starting from 7 d before the operation till 5 d after it). RESULTS: Portal venous inoculation of donor splenocytes combined with CsA significantly prolonged cardiac graft survival (n=6, P<0.05) that reached 31.00+/-3.23 d, and 2 of the 6 allografts survived for more than 35 d. Donor splenocytes injected via the systemic vein or third-party C57BL/6 mice splenocytes injected via the portal vein did not prolong graft survival (P>0.05). CsA alone or portal venous inoculation of donor-specific splenocytes alone also prolonged graft survival (P<0.05), with mean graft survival time of 18.50+/-2.59 d and 16.11+/-1.97 d respectively. CONCLUSION: Combination of portal venous inoculation of donor-specific splenocytes and CsA can prolong murine cardiac allograft survival, which is donor antigen-specific.     

紫外线照射的供体脾细胞预输注对大鼠同种异体神经移植的影响

目的：探讨大鼠尾静脉预输注经紫外线照射的供体脾细胞在同种异体坐骨神经移植中的作用。方法：20只雄性Wistar大鼠随机分为未经紫外线照射的供体脾细胞注射组（非照射组）、经紫外线照射的脾细胞注射组（照射组）两组，每组10只。未照射组注射未经紫外线照射的供体脾细胞，照射组注射经紫外线照射的脾细胞，7d后移植供体神经。术后7d行外周血T淋巴细胞亚群检查，术后8W行移植神经组织学检查。结果：照射组CD4^＋百分率、CD4^＋CD8^＋比值较非照射组明显降低（氏O．01，P〈0．05），CD8^＋百分率较非照射组明显升高（P〈0．01）。组织学检查显示，照射组的再生神经较非照射组多。结论：尾静脉内注射经紫外线照射的异基因脾细胞可诱导对异体神经移植的特异性免疫耐受。     

一种改良的异位工作型心脏移植模型

目的　为心脏移植的实验研究提供一种理想的异位工作型心脏移植模型。方法　SD大鼠作为供体和受体。受体行右肾切除术 ,并保留肾动静脉。工作型供心在保存期间进行自身肺动脉与左心耳端侧吻合 ,供心的血供由无名动脉与受体右肾动脉进行套管法吻合而建立。非工作型采用套管法分别连接供心无名动脉与右肾动脉、供体肺动脉与受体右肾静脉。移植成功后 1 0天切取供心 ,比较移植前后供心质量的改变 ,并利用langendorff离体灌注模型测定对照组及移植后两组供心的左室收缩压 (LVSP)、左心室内压变化速率 (±dp/dtmax)等血液动力学指标以评估心功能。结果　工作型供心萎缩程度低于非工作型 ,心功能明显优于非工作型。结论　工作型模型操作简单与非工作型模型相比更近于临床情况 ,值得推广。     

大鼠胰十二指肠移植模型建立方法的改进

目的：改进现有的胰十二指肠移植模型的建立方法，建立一种符合生理模式的大鼠胰十二指肠移植模型。方法：运用显微外科技术，对链脲佐菌素诱导的糖尿病大鼠进行胰十二指肠移植。供胰的静脉回流采用符合生理的门静脉系统回流途径，即供胰的门静脉与受体肠系膜上静脉行端侧吻合。供胰的腹主动脉与受体腹主动脉行端侧吻合。供体十二指肠节断与受体十二指肠行侧侧吻合。结果：共进行50次大鼠胰十二指肠移植手术，术后血糖正常且存活超过5天者共39例，手术成功率为78％。结论：该模型稳定、可靠，符合生理模式，可用于进一步实验研究。     

Hepatic venous outflow reconstruction in adult right lobe living donor liver transplantation without middle hepatic vein

Background It is difficult and challenging to reconstruct hepatic venous outflow in adult right lobe living donor liver transplantation (LDLT) without the middle hepatic vein (MHV). Excessive perfusion of the portal vein and venous outflow obstruction will lead to acute congestion of the graft, ultimately resulting in primary nonfunction. Although various reconstruction patterns have been explored in many countries, there is currently no clear consensus. In this study we describe a technique to prevent “chocking” of the graft at the outflow anastomosis with the inferior vena cava (IVC) in LDLT using right lobe graft without the MHV. Methods A retrospective analysis was conducted on clinical data from 55 recipients undergoing LDLT using right lobe grafts without the MHV or reconstruction of hepatic venous outflow. The donor’s right hepatic vein (RHV) was anastomosed with a triangular opening of the recipient IVC; the inferior right hepatic vein (IRHV), if large enough, was anastomosed directly to the IVC. The great saphenous vein (GSV) was used for reconstruction of significant MHV tributaries.Results No deaths occurred in any of the donors. Of the 55 recipients, complications occurred in 6, including hepatic vein stricture (1 case), small-for-size syndrome (1), hepatic artery thrombosis (1), intestinal bleeding (1), bile leakage (1), left subphrenic abscess and pulmonary infection (1). A total of three patients died, one from small-for-size syndrome and two from multiple system organ failure. Conclusions The multiple-opening vertical anastomosis was reconstructed with hepatic vein outflow. This technique alleviates surgical risk of living donors, ensures excellent venous drainage, and prevents vascular thromboses and primary nonfunction.     

三种不同重建肝静脉回流术式的背驮式肝移植临床对比研究

目的：探讨背驮式肝移植（PBLT）不同重建肝静脉回流术式的优缺点。方法：自1995年9月至2002年1月,对59例各种不同适应证的终末期肝病患者施行了63例次PBLT,其中4例为再次背驮式肝移植（RTLPB）.PBLT对肝静脉重建采用3种吻合方法:A组17例,采用经典式背驮式肝移植（standared piggyback liver transplantation,SPBLT）技术,即供肝肝上下腔静脉（sup-H-IVC）与受体成型的肝静脉行端端吻合术（EEAT）,为EEAT组：B组12例,采用改良的背驮式肝移植（APBLT）技术,即供、受体sup-H-IVC端侧吻合术（ESAT）,为ESAT组;C组34例,采用APBLT技术,即供肝肝后下腔静脉后壁与受体肝后下腔静脉前壁侧侧吻合（SSAT）,为SSAT组。结果：EEAT组与ESAT组均有肝静脉回流受阻综合征、肝功能恢复延迟等并发症,SSAT组无上述并发症。结论：SSAT组技术易掌握,避免了EEAT组和ESAT组技术上的弊病,减少了并发症,为肝移植术后康复提供了技术保障。     

国人肝静脉

肝静脉是唯一引流肝脏静脉血的脉管，它以数目众多，大小不等，各自开口于下腔静脉为特征，而与人体其他脏器静脉取逐级汇合成主干离开器官的形式不同。通过对肝静脉汇入下腔静脉的形式、部位和开口的形态，与门静脉的关系，管径及肝内吻合等方面的阐述，为肝段切除术，介入治疗，尤其是活体近亲肝移植术供、受体手术中处理肝静脉等提供解剖学依据，为临床应用提供参考。     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Simultaneous pancreas-kidney transplantation with enteric drainage of exocrine secretions

Objectives To simplify the enteric drainage (ED) procedure and to decrease surgical and metabolic complications in simultaneous pancreas-kidney transplantation (SPK) patients.Methods Between June 2000 and June 2002, nine patients with insulin-dependent diabetes mellitus(IDDM) and uremia underwent simultaneous pancreas-kidney transplantation. The arterial inflow of the pancreas was based upon the right external iliac artery, while venous drainage was systemic via the external iliac vein. The allografts‘ exocrine secretions were drained into the proximal jejunum via a two-layer hand sewn, side-to-side donor duodenum to proximal small bowel anastomosis afterreperfusion. No Roux-en-γ an astomosis of the jejunum was performed. The kidney graft was placed in the left iliac fossa. Quadruple immunosuppressive therapy with antilymphocyte globulin or anti-CD25 monoclonal antibody (Zenapax*), tacrolimus, mycophenolate mofetil and steroids was standard treatment in all patients.Results This procedure was successfully applied in all 9 patients without complication referable to the technique. All patients had achieved euglycemia and excellent renal function, and stopped being dependent on an external insulin source. Fasting serum glucose fell from 9.5 preoperatively to 4. 8mmol/L and remained stable thereafter. At the time this paper was written, the grafts from eight patients were functioning well.Conclusions Our primary experience suggests that SPK with ED without Roux-en-γ anastomosis represents a more physiologic milieu, and a viable alternation to replace the bladder (BD) as the primary route of drainage for exocrine secretions of the pancreas. It is a feasible and safer procedure.     

肝内门-体分流在大鼠肝缺血/再灌注损伤中的作用

目的探讨肝内门-体分流（IPSS）在大鼠肝缺St／再灌注（I／R）损伤中的作用和机制。方法健康雄性SD大鼠12只，作右侧颈动脉、颈静脉插管，开腹后，经回结肠静脉作门静脉插管，分别用以输血、输液、给药、留样、检测等。随机分为2组（每组6只）。假手术组（对照组）：术中只分离肝周围韧带，不作肝门阻断及再灌注。I／R组：进行45min的部分肝门阻断及60min的再灌注。待I／R组再灌注60min后，2组于相同时点经门静脉输注D-山梨醇（10mmol／L，0．2ml／min），同时取颈动脉、门静脉、肝静脉血各1ml待测山梨醇浓度。电磁血流量计测定门静脉血流量（PVF）、肝动脉血流量（HAF）。根据颈动脉、门静脉、肝静脉的山梨醇浓度及PVF、HAF，计算肝山梨醇摄取率、功能性肝血流量（FHBF）和肝内门-体分流量（IHSF）。结果与对照组相比，I／R组肝山梨醇摄取率和FHBF减少，IHSF增加（P〈0．01）。结论肝I／R过程中，IPSS开放、FHBF减少可能与再灌注损伤有关。     

猪胰肾联合移植动物模型的建立

目的:建立符合生理的猪胰肾联合移植的动物模型,研究胰肾联合移植的手术方法。方法:16只猪随机配对行胰肾联合移植8次,供胰、肾原位灌注后大块联合切取,将供肾动、静脉分别与受体左髂总动、静脉吻合,供胰门静脉与肠系膜上静脉(或脾静脉)吻合,含有腹腔动脉和肠系膜上动脉的腹主动脉袖片与右髂总动脉吻合,所带小段十二指肠与空肠吻合。结果:8例受体猪中除1例因术后内环境紊乱于术后当天死亡外,其余7例移植效果满意,术后移植胰、肾均即可发挥功能,受体存活超过7 d后予以处死。结论:建立门静脉回流胰液内引流式猪胰肾联合移植模型是可行的,且该术式符合生理特点,可用于临床。良好的外科技术是胰肾联合移植成功的基础。     

Establishment of a Model of Combined Pancreas-Kidney Transplantation in Pig

A model of combined pancreas- kidneytransplantation in large animal resembling clini-cal case was designed for studies on pathophysi-ologic changes,the inducement of immunotoler-ance,the regularity of chronic rejection and itsprophylactico- therapeutic measures of the recipi-ents and graft after transplantation.Materials and MethodsAnimalsTwenty- six local healthy mongrel pigs,both male and female,weighing ( 1 8.4± 2 .8)kg purchased from Experiment Animals Centreof Jiangsu Province were fas…