Heterotopic autotransplantation of segmental pancreas

本研究旨在探讨去神经支配的异位自体胰腺将其分泌物从门脉系统转移到体循环后的功能和形态学变化。1例62岁患者因胰腺癌行全胰切除术，并采用脾血管与股血管分支吻合的自体下半胰移植。自体移植胰腺组织学正常。术后糖代谢维持正常，IV-GTT试验显示血糖水平与术前一样正常，但IRI反应受损，出现早期分泌高峰。外瘘的胰腺外分泌物的量和淀粉酶浓度也没有减少。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、腺泡萎缩和肥大的胰岛组成 关于我们 .另一名患者，50岁男性，患有不可切除的胰腺癌，每天排出30- 92 g尿糖。为了改善他受损的糖代谢，我们切除了他的远端1/3胰腺并自体移植于大腿。手术后，他的每日尿糖排出量在术后第一个两周内降至0- 10 g，然后消失。然而，IV-GTT没有改善。实验研究表明，全胰切除后行自体左胰异位移植的犬，糖负荷后外周血胰岛素水平高于右胰切除的对照组，但无统计学意义。然而，去神经支配是否可能是自体胰腺移植动物外周胰岛素水平升高的原因，目前尚不清楚。根据这些观察，可以得出结论，异位自体移植胰腺可能提供了一些优势，在碳水化合物的控制比非移植之一。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