Wassef R, Cohen Z, Langer B
Dis Colon Rectum. 1985 Dec;28(12):908-11. doi: 10.1007/BF02554303.
The purpose of this study was to determine whether small intestinal transplantation could be considered as an alternative in the treatment of patients suffering from the short-bowel syndrome. The site of absorption of oral cyclosporine A was determined as were the changes that follow small intestinal transplantation. The interactions between the lipophilic cyclosporine A molecule and fat emulsion solutions used for total parenteral nutrition were investigated. Finally, a technique for harvesting the entire small bowel in man was developed. The absorption of oral cyclosporine A in normal dogs, and in bowel-resected, autotransplanted, and allotransplanted dogs was determined. Cyclosporine A levels were monitored in all animals. This demonstrated that cyclosporine A is absorbed through the small bowel and carried through the lymphatics; that absorption is decreased to 40 percent of normal after autotransplantation or allotransplantation without rejection. Rejection further hampers cyclosporine A absorption. Administration of olive oil alone enhances absorption of cyclosporine A. We also administered cyclosporine A IV to five dogs, with and without a concomitant infusion of fat emulsion solution (Intralipid). No changes in plasma cyclosporine A levels, in the clearance of cyclosporine A, or in the in vivo distribution of cyclosporine A were noted. Finally, dissections in six cadavers and in four brain-dead organ donors were performed, and a reproducible technique for harvesting the small bowel in man was established. In selected patients with the short-bowel syndrome, small intestinal transplant may be considered as an alternative therapy to home total parenteral nutrition.
本研究的目的是确定小肠移植是否可被视为治疗短肠综合征患者的一种替代方法。测定了口服环孢素A的吸收部位以及小肠移植后的变化。研究了亲脂性环孢素A分子与用于全胃肠外营养的脂肪乳剂溶液之间的相互作用。最后，开发了一种在人体获取整个小肠的技术。测定了正常犬、肠切除犬、自体移植犬和同种异体移植犬口服环孢素A的吸收情况。监测了所有动物的环孢素A水平。这表明环孢素A通过小肠吸收并经淋巴管运输；自体移植或同种异体移植且无排斥反应后，吸收降至正常水平的40%。排斥反应会进一步阻碍环孢素A的吸收。单独给予橄榄油可增强环孢素A的吸收。我们还对5只犬静脉注射环孢素A，同时给予或不给予脂肪乳剂溶液（英脱利匹特）。未观察到血浆环孢素A水平、环孢素A清除率或环孢素A体内分布的变化。最后，对6具尸体和4名脑死亡器官捐献者进行了解剖，并建立了一种在人体获取小肠的可重复技术。对于选定的短肠综合征患者，小肠移植可被视为家庭全胃肠外营养的替代治疗方法。
