辅助性同种异体肝肠联合移植术后急性排斥反应的监测

目的评价猪同种异体辅助性肝肠联合移植术后排斥反应的监测方法。方法将50头杂交长白猪分为3组．A、B组各20头各完成10次猪辅助性带胰头及十二指肠的同种异体肝肠联合移植术．其中B组术后予以免疫抑制治疗：C组10头完成交互的同种异体节段性小肠移植术10例。术后1、3、5、7、14、21及30d经移植肠远端造口取小肠黏膜经常规处理后。分别在光镜和电镜下观察并进行排斥反应评分。结果术后A组出现排斥反应的中位时间为8（7～12）d．迟于c组的5（3～5）d（P〈0．05）。术后1周，A组的排斥反应评分为1．11±0．20。低于C组（2．56±0．18，P〈0．05）；但比B组高（O．20±0．13，P〈O．05）。A组移植术后中位存活时问为9（7～25）d，C组为12（7～20）d．而B组术后全部成活超过30d．与以上两组比较，P〈0.05．差异有统计学意义。结论移植术后排斥反应通过肠造口取材进行监测方便有效。

Pathological monitoring of intestinal graft acute rejection in auxiliary en-bloc liver-small bowel transplantation

Objective To investigate the pathologic monitoring of intestinal graft rejection in auxiliary en-bloc liver-small bowel transplantation in pigs. Methods Fifty outbreed long-white pigs were randomized into three groups, and the auxiliary composite liver-small bowet allotransplantations were undertaken in 10 pigs in group A and group B while segment small bowel allotransplantations wereundertaken in 10 pigs in group C. Group A and C were not treated with immunosuppressive drugs while group B was treated with cyclosporine A and methylprednisolone. The postoperative intestinal graft rejections were monitored by biopsy through the jejunostomy or ileuostomy on 1, 3, 5, 7, 14, 21 and 30 days after operation. Through routine management, the specimens were directly examined via optical and electronic microscope respectively. Results As shown from pathological data, the median initial time of postoperative rejection in group A was 8 days (ranged from 7 to12), later than that in group C (5 days:ranged from 3 to 5),P<0.05). On the 7th day postoperatively, the rejection scores in group A was 1.11±0.20, lower than that in group C (2.56±0.18, P<0.05), but higher than that in group B (0.20±0.13, P<0.05). Ultrastructure also showed more severe intestinal graft rejection in intestinal transplantation than that in combined transplantation. The median survival time was 9 days (ranged from 7 to 25) in group A and 12 days (ranged from 7 to 20) in group C, while all the pigs in group B lived longer than 30 days. Conclusion The pathological assessment through the jejunostomy or ileuostomy biopsy is a convenient method to monitor the postoperative graft rejections in intestinal related transplantation.