| Project/Area Number |
02670536
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| Research Category |
Grant-in-Aid for General Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Research Field |
General surgery
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| Research Institution | The Institute of Medical Science, The University of Tokyo |
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Principal Investigator |
UCHIDA Hisanori Inst. Med. Sci., Uv. Tokyo, Dep. Surg., Professor, 医科学研究所・外科教授 (30050420)
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| Co-Investigator(Kenkyū-buntansha) |
INOUE Sumio Inst. Med. Sci., Uv. Tokyo Dep. Org. Transp., Clinical Assistant, 医科学研究所, 人工臓器移植科助手 (80147090)
NAKAYAMA Yoshisuke University Kitasato Dep. Surg. Assist. Professor, 医学部, 外科講師 (90155896)
NISHIMURA Yohji Inst. Med. Sci., Uv. Tokyo, Dep. Surg., Research Associate, 医科学研究所, 外科研究員 (10218208)
SUGIMOTO Hisayuki Inst. Med. Sci., Uv. Tokyo, Dep. Org. Transp., Assist. Prof., 医科学研究所, 人工臓器移植科講師 (20107428)
三田 勲司 東京大学, 医科学研究所, 助手 (30190672)
長尾 桓 東京大学, 医科学研究所, 助教授 (90143487)
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| Project Period (FY) |
1990 – 1991
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| Project Status |
Completed (Fiscal Year 1991)
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| Budget Amount *help |
¥2,100,000 (Direct Cost: ¥2,100,000)
Fiscal Year 1991: ¥700,000 (Direct Cost: ¥700,000)
Fiscal Year 1990: ¥1,400,000 (Direct Cost: ¥1,400,000)
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| Keywords | Pancreatico-duodenal allotransplantation / Enteric drainage / Bladder drainage / Gastric drainagi / Canine pancreas transplantation / Diagnosis of rejection / Electrolyte imbalance / 小腸ドレナ-ジ法 / 膀胱ドレナ-ジ法 / 胃ドレナ-ジ法 / 膵液胃ドレナ-ジ法 / 移植十二指腸生検 / 膵液細胞診 / 膵液アミラ-ゼ値 |
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| Research Abstract |
With regard to 4 different techniques of pancreatic duct management we have conducted the studies on surgical complications, diagnosis of rejection, and graft survival rates in canine pancreatico-duodenal allotransplantation. These 4 were enteric drainage, bladder drainage with long or short segment of the duodenum and gastric drainage. Deaths within 4 days after surgery were excluded from the results.
RESULTS, DISCUSSION AND CONCLUSION
Group 1 comprises 7 dogs with enteric drainage by anastomosing graft duodenum 10cm in length to recipient jejunum. Mean survival of recipients was 133+/-107(SD)days. Group 2 comprises 10 dogs with bladder drainage by anastomosing 10cm of graft duodenum to recipient urinary bladder. This group was subdivided into group 2a(n--5)anct group 2b(n=5)according to differences in management of post operative i. v. infusion. Special care was not taken for postoperative i. v. infusion except for regular fluid replacement in group 2a, whereas meticulous i. v. managem
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ent, was performed in dogs in group 2b according to changes of serum electrolytes. Mean survival of dogs in group 2a was 8.6<plus-minus>2.9(SD)days, whereas it was 16.0<plus-minus>5.8(SD)days in group 2b. Group 3 comprises 5 dogs with bladder drainage by anastomosing 5cm of duodenal segment to recipient urinary bladder for the purpose of determining whether loss of pancreatic or duodenal juice into urine has significant role for development of postoperative electrolyte imbalance and acidosis. Mean survival of recipients was 10.8<plus-minus>5.5(SD)days. Group 4 comprises 5 dogs with gastric, drainage by anastomosing 10cm of graft duodenum to recipient stomach. Mean survival of recipients in this group was 79.0<plus-minus>118(
In canine pancreatico-duodenal allotransplantation enteric drainage is physiological and pancreas graft survival rates were higher than other duct management techniques. On the other hand, dogs with bladder drainage developed severe dehydration and electrolyte imbalance and could not survive long. Meticulous fluid replacement therapy alleviated the complications and slight improvement of survival was obtained. Loss of pancreatic juice rather than duodenal juice into the urine had significant role in development of dehydration and electrolyte imbalance. In dogs with gastric drainage serial endoscopical studies demonstrated easy assess to diagnosis of rejection by biopsy of the graft duodenal mucosa. In dogs with bladder drainage daily determination of urinary amylase facilitated rejection of the graft. Therefore, if prevention of dehydration and electrolyte imbalance can be successful as in human pancreas allotransplantation, bladder drainage technique should be applied. Less
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