CAJ | 학술논문

目的：通过用静脉套管吻合和胰液膀胱内引流来改进并建立兔胰、肾联合移植（SPKT）小动物模型，探索手术难点的解决方法，掌握联合移植技术及该术式对受体生理机能的影响，探讨其临床应用价值。方法：选用日本大耳兔作 SPKT 的供、受体，切除受体双侧肾脏，供体肾脏原位吻合，供体胰腺吻合于另一侧。实验组用袖套法完成供体门静脉、肾静脉与受体肾静脉断端的吻合；对照组用缝合法完成静脉吻合。两组用缝合法完成动脉吻合，输尿管和胰管置管行膀胱内引流。结果：12只供体顺利完成胰腺和肾脏切取术；12只受体顺利完成胰肾联合移植术；供体肾脏、胰腺移植后迅速恢复血液循环，无出血及漏血，术后3只死于持续性低血压。实验组5只受体术后平均生存期（4．0±0．7）d，对照组4只受体术后平均生存期（3．0±0．4）d，存活期胰、肾功能基本正常。结论：良好的外科技术是SPKT 成功的基础，改进的 SPKT 术式手术时间短、受体创伤小，极大地减少术后早期并发症和提高移植物存活率，对是否应用于临床有一定的参考价值。
목적：통과용정맥투관문합화이액방광내인류래개진병건립토이、신연합이식（SPKT）소동물모형，탐색수술난점적해결방법，장악연합이식기술급해술식대수체생리궤능적영향，탐토기림상응용개치。방법：선용일본대이토작 SPKT 적공、수체，절제수체쌍측신장，공체신장원위문합，공체이선문합우령일측。실험조용수투법완성공체문정맥、신정맥여수체신정맥단단적문합；대조조용봉합법완성정맥문합。량조용봉합법완성동맥문합，수뇨관화이관치관행방광내인류。결과：12지공체순리완성이선화신장절취술；12지수체순리완성이신연합이식술；공체신장、이선이식후신속회복혈액순배，무출혈급루혈，술후3지사우지속성저혈압。실험조5지수체술후평균생존기（4．0±0．7）d，대조조4지수체술후평균생존기（3．0±0．4）d，존활기이、신공능기본정상。결론：량호적외과기술시SPKT 성공적기출，개진적 SPKT 술식수술시간단、수체창상소，겁대지감소술후조기병발증화제고이식물존활솔，대시부응용우림상유일정적삼고개치。
Objective Through the casing with vein anastomosis and pancreatic juice inside bladder drainage to improv and estab-lish the model of simultaneous pancreas and kidney transplantation in small animals such as rabbit,in order to explore the solutions of difficulties in surgery ,to master combined transplantation techniques and To observe the influence of the operation of receptor physiol-ogy and explore its clinical application value.Methods Choose the Japanese big ear rabbits as receptors and donors of SPKT,receptors are under bilateral renal resection,Donors’kidney is in situation,donor pancreas anastomosis on the other side.The experimental group With cuff method to anastomosis the donor portal vein and renal vein with renal vein of receptor and the control group are com-plete the venous anastomosis with stitching;the two groups are complete arterial anastomosis with stitching;the Ureters and pancreatic duct are catheter with bladder drainage.Results The pancreas and kidney of 12 donors were cut out successfully;12 acceptors were successfully completed by the combined kidney and pancreas transplantation,the kidney and pancreas of Donor are rapidly restore blood circulation after transplantation,no bleeding and blood leakage,three acceptor is dead after operation in persistent low blood pressure,The experimental group of 5 acceptors’average survival time is (4.0 ±0.7)d After operation;The control group of 4 ac-ceptors’average survival time is (3.0 ±0.4)d After operation .Conclusion A good surgical technique is the foundation of SPKT, The time of SPKT’s surgery is short and the wound is small,to reduce early post -operational complications greatly and to improve the Graft survival rate ,whether applied to clinical to have certain reference value.