| [Background];Diabetes is a disease effecting human beings across the globe.Having one of the highest mortality rates and disability(amputations).Although an improved life style and discovery of insulin has played an important role in the treatment of diabetes but still there are limitation to insulin treatment and complications in long term use.So researchers established that successful pancreas transplantation is the only best treated for diabetes.Pancreas transplantation was started in early 19th century dogs played an important part in diabetes and pancreas transplantation research.Most of the research is carried on dogs and later applied for the well being of human.With passages of time improvements occurred in pancreas transplantation in dogs and first human transplantation was performed in 196 based on dog model.In China Pancreas transplantation was started late.So researchers are trying to establish a simultaneous kidney and pancreas transplantation.[Objective];To establish simultaneous pancreas kidney transplantation model in canines for the treatment of type 1 diabetes.[Material and Method];Local dogs 22 in number,two for every time weight of dogs was 13-16Kg with age 18-24 months,for the recipient body weight similar in females as compare to the males,fasting 12 hours before the surgery,and no water intake 4 hours post operations.Dogs divided in 11 groups randomly each having a donor and a recipient.No tissue matching was done the dogs were provided by the Laboratory Animal Center of Kunming Medical University.[Results]Donor pancreas transplantation surgery,1 donor died because of anesthesia,1 donor gastero duodenal artery was damaged by mistake during surgery which was repaired with intercostal arterial anastomosis the blood supply of the duodenum was restored in a good manner.2 cases of recipient remission showed persistent apathy and died within 1 day.Immediate reopen after death to find the cause of the death,we found pancreatic ischemia and necrosis black in color arterial thrombosis at the point of anastomosis.1 case of postoperative vomiting occurred on the 2nd day o surgery we measured fasting blood glucose which was increased up to 17.1 mmol/L,to make up 0.45%sodium chloride solution was given,on re laparotomy we found transplanted pancreatic vascular torsion,poor venous outflow tract,slightly darker pancreas,in order to reset,both sides of the tissue sutured and fixed to the side of peritoneum,blood glucose was gradually decreased to 10.4 mmol/L.1 case of postoperative hematuria was reported on the 3rd day after surgery,then turned to dark blood urine,after death of the dog.It was immediately reopen to find the cause,duodenum necrosis was found.The color of duodenum was dark(blackish),slightly color of the pancreas,no thrombosis was found in arteries and veins,kidney Color rose pink,the volume shrinks.Smooth recovery in rest of the recipients after surgery,renal function was restored,transplant pancreas,kidney survival time of 5?6 d.All the intestine-bladder anastomotic patency,no anastomotic leakage was found in recipients from 1?3 d after a different degree of hematuria,most of in first 3 days after the urine change to normal,while in some recipient dark red urine was seen till 6th to 7th day of surgery.Donor surgery time(min)72±10Mean cold ischemia time(min)126±16Average perfusion volume(mL)1 020±210Receptor surgery time(min)141.14±18.25Portal vein anastomosis time(min)32.30±3.18Abdominal aortic anastomosis time(min)29.61±3.45Renal vein anastomosis time(min)23.40±1.59Renal artery anastomosis time(min)24.12±2.12Mean blood loss(mL)320±20[Conclusion]11 cases of pancreas transplantation in dogs were performed.1 died during anesthesia.With 10 transplantations net percentage of success was 90.9%and 1 case of duodenal necrosis(9.1%).Complications were seen in 2 cases,that includel case of anastomotic artery thrombosis I case of vascular graft torsion(9.1%).Function of endocrine and exocrine was basically normal in 9 recipients,but rejection occurred gradually in graft kidney,duodenum and pancreas from 3 to 7 postoperative days,finally graft dysfunction led the recipients to death.Although there are still some problems yet need to be solved,to reduce the technical complications caused by early complications,to improve the graft ischemia-reperfusion injury caused by the internal environment disorders,there is a need to do further exploration.The work on dog's whole pancreatic duodenal kidney transplantation leads to the surgical foundations for clinical simultaneous pancreas kidney transplantation.Our experiments show that good results can be obtained with clinical simultaneous pancreas kidney transplantation to treat type 1 diabetes... |
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