Florack G, Sutherland D E, Cavallini M, Najarian J S
Am J Surg. 1983 Nov;146(5):565-74. doi: 10.1016/0002-9610(83)90289-1.
Heterotopic segmental pancreatic autotransplantation in dogs is more appropriate than allograft models for the investigation of several problems associated with transplantation. We have defined the anatomic variations of blood supply in the pancreatic tail and designed various modifications of vascular anastomosis to the iliac vessels in order to eliminate technical failures, such as thrombosis, as much as possible. In 187 of 240 dogs (77.9 percent), the pancreatic artery originated from the splenic artery and the pancreatic vein entered the splenic vein (normal anatomy). The main venous variation was direct confluence of the pancreatic and portal veins (12.1 percent), and the main arterial variation was origin of the pancreatic artery from the superior mesenteric artery (10 percent). Ninety-seven animals with normal anatomy qualified for a comparative study of seven methods of segmental pancreatic autotransplantation. Venous anastomoses were always performed in an end-to-side fashion between the splenic and external iliac veins. Arterial anastomosis techniques follow. Group I: interposition of the splenic artery into the external iliac artery; (14 days, failure rate 50 percent), Group II: end-to-end arterial anastomosis of the splenic artery to a long external iliac artery segment with the graft directed caudad, resulting in an acute curve to the vessel loop (8 dogs, failure rate 38 percent); Group III: end-to-end arterial anastomosis to a long external iliac artery with the graft directed cephalad, resulting in a gentle curve to the vessel loop (11 dogs, failure rate 36 percent); Group IV: end-to-end arterial anastomosis to a short external iliac artery stump (20 dogs, failure rate 20 percent); Group V: same as in Group IV with the addition of a distal splenic arteriovenous fistula (12 dogs, failure rate 17 percent); Group VI: end-to-side anastomosis of the splenic artery to the external iliac artery (31 dogs, failure rate 6 percent); Group VII: same as in Group VI but with the addition of an arteriovenous fistula of the distal splenic vessels (1 dog, failure rate 0). The end-to-side technique proved to be straight-forward and reliable. The low failure rate with this method allows metabolic preservation and other aspects of pancreatic transplantation to be studied and the results to be interpreted without the influence of a high complication rate from the operation itself.
对于研究与移植相关的几个问题而言，犬异位节段性胰腺自体移植比同种异体移植模型更为合适。我们已明确了胰尾血供的解剖变异情况，并设计了对髂血管进行血管吻合的多种改良方法，以便尽可能消除诸如血栓形成等技术故障。在240只犬中，有187只（77.9%）的胰动脉起源于脾动脉，胰静脉汇入脾静脉（正常解剖结构）。主要的静脉变异是胰静脉与门静脉直接汇合（12.1%），主要的动脉变异是胰动脉起源于肠系膜上动脉（10%）。97只解剖结构正常的动物符合进行节段性胰腺自体移植七种方法比较研究的条件。静脉吻合总是在脾静脉与髂外静脉之间以端侧方式进行。动脉吻合技术如下。第一组：将脾动脉插入髂外动脉；（14天，失败率50%），第二组：脾动脉与一段长的髂外动脉进行端端动脉吻合，移植物指向尾侧，导致血管环出现锐角弯曲（8只犬，失败率38%）；第三组：与一段长的髂外动脉进行端端动脉吻合，移植物指向头侧，导致血管环出现平缓弯曲（11只犬，失败率36%）；第四组：与短的髂外动脉残端进行端端动脉吻合（20只犬，失败率20%）；第五组：与第四组相同，但增加了远端脾动静脉瘘（12只犬，失败率17%）；第六组：脾动脉与髂外动脉进行端侧吻合（31只犬，失败率6%）；第七组：与第六组相同，但增加了远端脾血管动静脉瘘（1只犬，失败率0）。端侧技术被证明简单且可靠。该方法的低失败率使得能够在不受手术本身高并发症率影响的情况下研究胰腺移植的代谢保存及其他方面，并对结果进行解读。
