Heterotopic autotransplantation of segmental pancreas

本研究的目的是评价异位自体移植胰腺的功能和形态变化，该胰腺是去神经的，其激素分泌进入体循环而不是门静脉系统。62岁患者因胰腺癌行全胰切除术，并经脾血管与股血管分支吻合行胰腺远端自体移植。自体移植胰腺组织学正常。术后患者的碳水化合物代谢维持正常，IV-GTT试验显示血糖水平与术前一样正常，但IRI反应因早期分泌高峰的消失而受损。胰外分泌量和淀粉酶浓度均未减少。然而，当他在术后6个月死亡时，胰腺由小叶间和小叶内纤维化、腺泡萎缩和肥厚的胰岛组成。另一名患者，50岁男性，患有不可切除的胰腺癌，每天排出30-92g的尿糖。为了改善其受损的碳水化合物代谢，切除了患有严重慢性胰腺炎的胰腺远端三分之一，并在其大腿处进行了自体移植。术后两周每日尿糖量降至0-10g，术后消失。然而，IV-GTT并没有得到改善。实验研究表明，在全胰腺切除术后接受左胰腺异位自体移植的狗，糖负荷后外周胰岛素水平高于切除右胰腺的对照组，但统计学上不显著。然而，在自体胰腺移植的动物中，去神经支配是否可能是导致外周胰岛素水平升高的原因尚不清楚。基于这些观察结果，我们认为异位自体移植胰腺在碳水化合物控制方面可能比未移植胰腺更有优势。少

The aim of the present study was to evaluate the function and morphological change of heterotopic autotransolanted pancreas which was denervated and secreted its hormons into the systemic circulation instead of the portal system. A 62 years old patient had undergone total pancreatectomy for pancreas cancer and autotransplantation of the distal half of pancreas by anastomosis of the splenic vessels to the branches of femoral vessels. The autotransplanted pancreas was normal in histology. Postoperatively, his carbohydrate metabolism was maintained normally and IV-GTT test showed normal blood glucose levels as well as that done preoperatively, though IRI response was impaired with abscence of an early secretory peak. Also the pancreatic exocrine secretion from the external fistula did not decrease in volume and in amylase concentration. However, when he died at the 6th postoperative month, the pancreas consisted of inter- and intra-lobular fibrosis, acinar atrophy, and hypertrophic islets … More . Another patient, 50 years old man with unresectable pancreatic cancer, excreted a 30-92g of urine sugar daily. In order to improve his impaired carbohydrate metabolism, the distal a third of pancreas with severe chronic pancreatitis was resected and autotransplanted at his thigh. Following the operation, his daily urinary glucose output decreased to 0-10g during the first post-operative two weeks and then disappeared. However, IV-GTT was not improved. Experimental studies demonstrated that peripheral insulin levels after glucose load in the dogs which received heterotopic autotransplantaion of the left limb of pancreas following total pancretectomy were higher, though not significantly in statistics, than those in the control in which the right limb of pancreas was removed. However, it remains to be unresolved whether denervation may be responsible for the higher level of peripheral insulin in the animals with autotransplanted pancreas. Based on these observations, it is concluded that heterotopic autotranasplanted pancreas may offer some advantage in the carbohydrate control over the non-transplanted one. Less