Villegas Alvarez F, Jiménez Bravo Luna M A, Murgía Muñoz M T, Lira Ortega M, Roldán Calderas R M
Unidad de Investigación en Salud Infantil, Instituto Nacional de Pediatría, México, D.F.
Rev Gastroenterol Mex. 1997 Jan-Mar;62(1):14-21.
Total enteral transplant associated or not to other abdominal organs has a high degree of morbidity due to immunologic and functional complications that have limited its therapeutic application. Segmentary transplants have demonstrated experimentally to have a better control to immune response, however there are still doubts on its functional effectiveness in terms of other segments.
In order to evaluate surgical and functional morbidity without immunologic interference, syngenic segmentary enteral transplants were done, from three different levels in the intestine.
Growing syngenic Lewis rats were randomly divided into five groups; four of them had 90% enterectomy with a simultaneous transplant of a 30% of the proximal, medial and distal segments in the first three groups and 90% in the fourth one. The fifth group was used as a control.
Of the 54 rats that were transplanted, one third developed late complications. Only half of them showed controllable causes, the complications were proportional in all groups. Among surviving four months after transplant, no group had stopped growing, however, the proximal transplant group had significant (P < 0.05) deficit in weight with respect to the other groups. All the other groups showed growth patterns similar to the control group. Plasma concentrations of tryglicerydes, cholesterol and glucose after the maltosa test were similar in all animals. Low albumin concentrations were observed only in the proximal transplant group (P < 0.05).
Medial and listal segmentary transplants showed the best functional adaptability in terms of ponderal growth, similar to animals with total enteral restitution or intestinal integrity.
全肠移植无论是否与其他腹部器官相关,由于免疫和功能并发症,其发病率都很高,这限制了其治疗应用。节段性移植在实验中已证明对免疫反应有更好的控制,然而,就其他节段而言,其功能有效性仍存在疑问。
为了在无免疫干扰的情况下评估手术和功能发病率,进行了同基因节段性肠移植,取自肠道的三个不同水平。
将生长中的同基因Lewis大鼠随机分为五组;其中四组进行了90%的肠切除术,前三组同时移植了30%的近端、中段和远端节段,第四组移植了90%。第五组用作对照。
在54只接受移植的大鼠中,三分之一出现了晚期并发症。其中只有一半显示出可控原因,并发症在所有组中呈比例分布。在移植后存活四个月的大鼠中,没有一组停止生长,然而,近端移植组相对于其他组体重有显著(P<0.05)下降。所有其他组的生长模式与对照组相似。在麦芽糖试验后,所有动物的甘油三酯、胆固醇和葡萄糖血浆浓度相似。仅在近端移植组中观察到低白蛋白浓度(P<0.05)。
就体重增长而言,中段和远端节段性移植显示出最佳的功能适应性,类似于全肠恢复或肠道完整的动物。