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題名 | Octreotide Effects on Pancreatic Graft Pancreatitis in Inbred Pigs=同種豬胰臟移植模式中Octreotide影響胰臟植體發炎之研究 |
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作者 | 趙世晃; 李伯皇; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 29:4 民85.07-08 |
頁次 | 頁330-335 |
分類號 | 437.26 |
關鍵詞 | 豬; 胰臟移植; 胰臟植體發炎; Pancreas; Transplantation; Octreotide; Sandostatin; Pancreatitis; Reperfusion injury; |
語文 | 英文(English) |
中文摘要 | 以純種豬之胰臟移植模式可以探討非免疫性排斥的病理變化,例如藥物 對胰臟植體術後發炎與缺氧壞死的影響。Octreottde可抑制胰臟的外分泌、降低澱 粉酵素等消化酵素之釋出,唯其對腹腔血流有抑制作用,可能加重發炎胰臟之缺 氧傷害。利用呂宋小耳種迷尼純種豬作胰十二指腸移植,移植後胰臟可維持胰全 切除動物之正常血糖兩週以上,唯其血中澱粉酵素在一週內明顯上升。在控制組 (n:6)未接受Octreottde注射者,第五天澱粉酵素3939±180IU/L,比注射Octreottde(術 後2Hglkg/小時X6小時。其後20pg/kg/8小時X5~7天)組(n:5)之1905±495U/L明顯偏高 (p>0.05)。控制組之LDH值則在第三天後比注射Octreottde組低,不過只有第五天, 第七天之值有差別意義(P<0.05)。在第四天之HMPAO-Tc99M同位素血流攝影則以 注射octreottde組之植體血流較低,與肝顯影度之對比,控制組55.2±11.5、注射組 44.9±10.1,唯統計無差別意義(P>0.05),在二週內之血糖值,與第七天之IVGTT 之K值,兩組比較並無有意義差別。在二週後解剖之植體發現,兩組並無明顯之 差異,植體表現局部發炎或壞死後纖維增升現象。 僅售使用Octreotide在胰臟移植後降低血中澱粉酵素之作用,但是對植體血流確有 抑制作用。在本實驗中雖未造成足以影響移植成績的效果,但是其加重缺氧傷害 潛在危險不容忽視。 |
英文摘要 | To evaluate the effect of octreotide on the pancrearic graft perfusion andgraft pancreatitis after pancreas transplantation, Lee-Sung strain of miniature inbred pigs (n=24) were used both as donors and as pancreatectomizedrecipients for heterotopic pancreaticoduodenal transplantation. Followinggraft procurement, Belzer-University Wisconcin (UW) solution was used aspreservation solution. The cold ischemia time was in average 2 hr 31 min.The portal vein of the graft was anastomosed to the distal inferior venacava of the recipient, and the Carrel's aortic patch of the graft includingthe orifices of the superior mesentery artery and the celiac axis was anastomosed to the right common iliac artery of the recipient. The pancreaticsecretion of the graft was drained through a segment of duodenum by aduodeno-duodenostomy. For the recipients in the experimental group (n=6), intravenous infusion (from 30 min before reperfusion) of 2 mg/kg/hr ofoctreotide was also administered for 6 hours, followed by a subcutaneousdose of 20 mg/kg every 8 hours for 5 to 7 days. Octreotide was not administered in the control group (n=6>). Graft function and pancreatitis was monitored by serial evaluations of blood sugar, serum amylase, lactate dehydrogenase (LDH), and by hexamethylpropylene amineoxide (HMPAO)-Tc99M scintigraphy and intravenous glucose tolerance test (IVGTT) in posttransplant period. The animals were sacrificed 2 weeks after transplantation. All the pancreatic grafts showed a prompt endocrine function manifested by blood glucose <200 mg/dl within the first 24 hours and remainednormoglycemic thereafter. In comparison, the glucose levels between thetwo groups were not significantly different during the two weeks of observation. The average k value of post-transplant IVGTT was -2.52 ± 0.65 inthe octreotide-infused group, and -2.22±0.27 in the control group (p>0.10).The serum amylase levels were higher in the control group than those ofthe octreotide-injected group (3939±1801 vs 1905±495 U/L, p<0.05). However, serum LDH was significantly lower at day 5 in the control group(1789±1087 vs 3178±609 U/L, p<0.05). The HMPAO-Tc99M scintigraphy revealed that pancreas/liver intensity ratios were lower with octeotide injection (44.9±10.1 vs 62.3±12.5, p<0.05). Histology of the grafts of bothgroups at day 14 showed a variety of inflammatory reactions and focalnecrosis in the grafts. However, there was no evidence of pathological difference observed between the two groups. In conclusion, octreotide inhibitshyperamylasemia following pancreas transplantation. It also reduces graftperfusion. The normoglycemic effect of the graft remains unchanged usingoctreotide, yet a poltential risk of increasing ischemic damage to the graftwith octreotide should be guarded. |
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