Marsh C L, Perkins J D, Barr D, Miller A R, Carpenter H A
Section of Transplantation Surgery, Mayo Clinic, Rochester, Minn 55905.
Surgery. 1990 Feb;107(2):177-81.
Present methods of monitoring for allograft dysfunction in pancreaticoduodenal transplantation (urinary amylase, scintigraphy) give indirect evidence and do not consistently allow recognition of early, potentially reversible rejection from other causes of allograft dysfunction. For better diagnosis of allograft dysfunction, adequate tissue specimens must be obtained without trauma to the allograft. We devised a cystoscopically directed needle biopsy technique to obtain tissue from the canine pancreaticoduodenal allograft. This technique is made feasible by a duodenocystostomy similar to that in human pancreaticoduodenal transplantation. The duodenum acts as a port of entry for the biopsy instruments, providing access to the pancreas. A 24F side-viewing nephroscope is used to view the duodenum. The tissue specimen is obtained with an 18-gauge, 350 mm Menghini aspiration needle inserted by way of the nephroscope through the duodenum and into the pancreas. Pancreaticoduodenal allotransplantation with a duodenocystostomy for exocrine drainage was performed in 18 dogs. Of 59 serial biopsy specimens obtained, 41 (69.5%) were adequate for pathologic evaluation. The principal complication associated with the technique was minimal bleeding at the biopsy site, occurring in 22 of the 59 biopsy procedures. This cystoscopically directed biopsy technique appears to be safe, often obtains adequate tissue for diagnosis, and may be directly applicable for distinguishing causes of allograft dysfunction in human pancreaticoduodenal transplantation.
目前用于监测胰十二指肠移植中同种异体移植物功能障碍的方法（尿淀粉酶、闪烁扫描）只能提供间接证据，无法始终如一地识别同种异体移植物功能障碍的其他原因导致的早期、潜在可逆性排斥反应。为了更好地诊断同种异体移植物功能障碍，必须在不损伤同种异体移植物的情况下获取足够的组织标本。我们设计了一种经膀胱镜引导的针吸活检技术，用于从犬胰十二指肠同种异体移植物获取组织。通过类似于人类胰十二指肠移植中的十二指肠膀胱造口术，该技术变得可行。十二指肠作为活检器械的进入端口，为进入胰腺提供了途径。使用24F侧视肾镜观察十二指肠。通过肾镜将18号、350毫米的Menghini抽吸针经十二指肠插入胰腺来获取组织标本。对18只犬进行了带有十二指肠膀胱造口术用于外分泌引流的胰十二指肠同种异体移植。在获取的59份连续活检标本中，41份（69.5%）足以进行病理评估。与该技术相关的主要并发症是活检部位轻微出血，在59次活检操作中有22次出现。这种经膀胱镜引导的活检技术似乎是安全的，常常能获取足够用于诊断的组织，并且可能直接适用于区分人类胰十二指肠移植中同种异体移植物功能障碍的原因。
