不同热缺血时间犬自体胰移植物功能状态及存活率的实验研究

目的探讨热缺血时间较长犬胰腺移植物功能和组织形态变化状态,研究不同热缺血时间条件下移植物存活率及供胰耐受热缺血的时限。方法根据供胰热缺血不同时间30、60、90、120 min分组,用UW液保存24 h,然后行自体移植,术后连续观察血糖、静脉葡萄糖耐量试验(IVGTT)、胰液淀粉酶、胰液分泌量、血液中胰岛素含量,并进行病理学检测。结果30 min组和60 min组在术后2~3 d即可恢复至正常范围,而在90 min组和120 min组术后1周血糖不能恢复至正常。IVGTT K值在未热缺血组3、0 min组和60 min组在术后1周>1,而在90 min组和120 min组<1。30 min组和60 min组术后胰液淀粉酶、胰液分泌量、血液中胰岛素含量明显高于90 min组和120 min组(P<0.05)。热缺血30、60、90、120 min各组移植物存活率分别为100%、100%、66.7%、0%。结论移植胰腺经过30~60 min热缺血,UW液保存24 h后移植物生存良好。热缺血时间超过90 min,移植物结构和功能难以恢复,存活率明显降低。

Effects of warm ischemia injury on pancreatic functional status and survival of pancreatic graft in canines

Objective To investigate the changing patterns of function and posttransplantive survival of pancreatic graft in different warm ischemia time(WIT) in canines and determine the maximal limitation of pancreatic graft to warm ischemia.Methods Based on the WIT(30,60,90 and 120 min),the canines were randomized into 4 groups.The canines were preserved by the UW solution cold storage method for 24 h before transplantation.Blood sugar(BG),intravenous glucose tolerance test(IVGTT) K value and plasma insulin level were determined in the 1st week after pancreas transplantation.The flow of and amylase in pancreatic juice during the first week were also detected.The pancreatic cortex was extracted for morphological analysis and ultrastructural study. Results The functional success rates of pancreatic grafts were 100%,100%,67.7% and 0% 30 min,60 min,90 min and 120 min after warm ischemia,respectively(P<0.05).Light microscopy and electron microscopy showed that hisomorphological changes of the pancreas were significantly lesser in canines receiving 30-and 60-min warm ischemia than in those undergoing 90-and 120-min warm ischemia(P<0.05).Conclusions Canine pancreatic grafts can be safely subject to warm ischemia within 60 min.When WIT is prolonged to 90 min,the recipients' survival rate is severely decreased and both function and histological structure of the pancreatic grafts are irreversibly damaged.