Department of Plastic Surgery, University of Tokyo, Tokyo, Japan.
PLoS One. 2012;7(9):e44310. doi: 10.1371/journal.pone.0044310. Epub 2012 Sep 6.
Colostomy is conventionally the only treatment for anal dysfunction. Recently, a few trials of anorectal transplantation in animals have been published; however, further development of this technique is required. Moreover, it is crucial to perform this research in dogs, which resemble humans in anorectal anatomy and biology. We designed a canine anorectal transplantation model, wherein anorectal autotransplantation was performed by anastomoses of the rectum, inferior mesenteric artery (IMA) and vein, and pudendal nerves. Resting pressure in the anal canal and anal canal pressure fluctuation were measured before and after surgery. Graft pathology was examined three days after surgery. The anal blood supply was compared with that in three beagles using indocyanine green (ICG) fluorescence angiography. The anorectal graft had sufficient arterial blood supply from the IMA; however, the graft's distal end was congested and necrotized. Functional examination demonstrated reduced resting pressure and the appearance of an irregular anal canal pressure wave after surgery. ICG angiography showed that the pudendal arteries provided more blood flow than the IMA to the anal segment. This is the first canine model of preliminary anorectal autotransplantation, and it demonstrates the possibility of establishing a transplantation model in dogs using appropriate vascular anastomoses, thus contributing to the progress of anorectal transplantation.
肠造口术通常是治疗肛门功能障碍的唯一方法。最近，已经有一些关于动物直肠肛门移植的试验发表；然而，这项技术还需要进一步的发展。此外，在与人类肛门解剖和生物学相似的犬类身上进行这项研究至关重要。我们设计了一种犬直肠肛门移植模型，通过直肠、肠系膜下动脉（IMA）和静脉以及阴部神经的吻合进行直肠肛门自体移植。在手术前后测量肛门静息压和肛门压力波动。术后 3 天检查移植物病理。使用吲哚菁绿（ICG）荧光血管造影术比较了 3 只比格犬的肛门血液供应。直肠肛门移植物有来自 IMA 的充足动脉血液供应；然而，移植物的远端充血和坏死。功能检查表明，手术后静息压降低，肛门压力波出现不规则。ICG 血管造影显示，阴部动脉向肛门段提供的血流多于 IMA。这是初步的犬直肠肛门自体移植模型，它证明了通过适当的血管吻合建立犬直肠肛门移植模型的可能性，从而推动了直肠肛门移植的发展。
