Hashimoto N, Ishii H, Kitada T, Utsunomiya J
Second Department of Surgery, Hyogo College of Medicine, Japan.
Hepatogastroenterology. 1992 Dec;39(6):511-4.
Small bowel transplantation has proved feasible in rats and in larger animal, but several important questions have yet to be answered before it becomes a potential therapy in man. One consideration is the site of venous outflow of the allograft. Portal drainage, however, re-establishes the physiological route of venous outflow, while systemic drainage creates a partial mesocaval shunt, the metabolic consequences of which have not been studied in detail. Using the canine model in partial mesocaval shunt and porta-caval shunt, we compared the metabolic and histological changes following each shunt. The metabolic changes in Eck were hyperammonemia and amino acid imbalance, while those in partial mesocaval shunt were similar to controls. The histological appearance of the liver in Eck was atrophy, fatty infiltration and deglycogenation, while that in partial mesocaval shunt was completely normal except for minimal fatty degeneration. These data suggest that there is no metabolic or histological disadvantage of systemic venous drainage as compared with control, and because of its technical simplicity, systemic venous drainage may be preferable in small bowel transplantation.
小肠移植已在大鼠和大型动物身上证明是可行的，但在成为人类潜在治疗方法之前，还有几个重要问题有待解答。一个需要考虑的因素是同种异体移植物的静脉流出部位。然而，门静脉引流重新建立了静脉流出的生理途径，而全身引流则形成了部分肠系膜上腔静脉分流，其代谢后果尚未得到详细研究。我们使用犬类模型进行部分肠系膜上腔静脉分流和门腔静脉分流，比较了每种分流后的代谢和组织学变化。艾克分流术（Eck）的代谢变化是高氨血症和氨基酸失衡，而部分肠系膜上腔静脉分流的代谢变化与对照组相似。艾克分流术（Eck）中肝脏的组织学表现为萎缩、脂肪浸润和糖原脱失，而部分肠系膜上腔静脉分流中肝脏的组织学表现除了有轻微脂肪变性外完全正常。这些数据表明，与对照组相比，全身静脉引流在代谢或组织学方面并无劣势，并且由于其技术简单，在小肠移植中全身静脉引流可能更可取。
