AIM: Several neural and hormonal factors are known to affect motility of sphincter of Oddi (SO). The major roles of SO are to regulate the flow of bile and pancreatic juice into the duodenum and to prevent the reflux ...AIM: Several neural and hormonal factors are known to affect motility of sphincter of Oddi (SO). The major roles of SO are to regulate the flow of bile and pancreatic juice into the duodenum and to prevent the reflux of duodenal contents into the biliary and pancreatic duct. After pancreas transplantation, graft SO was denervated and graft pancreatitis might have relations to SO motility. The motilityof SO after canine pancreas transplantation with bladder drainage was investigated. METHODS: Normal canine SO manometry and pancreas graft SO manometry after pancreas transplantation with bladder drainage were performed in seven dogs respectively before and after cholecystokinin (CCK) administration. Data of SO basal pressure, contraction frequency, amplitude and motility index after transplantation and CCK administration were compared with that in controls and before CCK administration.RESULTS: SO showed regular contractions with a certain basal pressure in control dogs. After transplantation, the graft SO basal pressure and contraction frequency were higher than that in controls, but the amplitude decreased (P＜0.01). There was no great difference in SO motility index.CCK administration could relax normal SO but stimulate graft SO after pancreas transplantation with bladder drainage.After CCK administration, SO basal pressure, frequency and motility index were increased significantly (P＜0.05), in comparison with that before administration. The amplitude remained unchanged (P＞0.05), in comparison with that before CCK administration.CONCLUSION: After auto-pancreas transplantation with bladder drainage, canine SO motility was inhibited. Basal pressure and frequency increased but amplitude decreased.CCK administration after transplantation had an inhibitory effect on canine SO instead of a relaxation effect observed in normal canine SO. This will increase the resistance of SO to the pancreatic juice flow and induce pancreatic juice stagnation and can not prevent reflux of urine and duodenal contents when the bladder pressure is increased to a certain extent, which may cause graft pancreatitis.展开更多
Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor a...Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor accessibility to the tumor region.Ex vivo surgery followed by intestinal autotransplantation(IATx)is a relatively novel surgical strategy to offer chances for complete resection in such hopeless circumstances.This review aims to assess potential surgical indications,operative techniques and clinical outcomes after IATx.Currently the main indications reported for IATx broadly include pancreatic,mesenteric and retroperitoneal neoplasms closely involving the superior mesenteric vessels.The preliminary results show that radical resection can be effectively achieved in carefully selective patients.Although perioperative morbidity and mortality are relatively high,there are several long-term survivors,particularly after complete resection of benign and low-grade tumor.Early tumor recurrence,however,remains a major problem in patients with high-grade tumor,particularly pancreatic ductal carcinoma.In conclusion,IATx allows patients with selected abdominal neoplasms involving themajormesenteric vessels to be completely resected.However,this aggressive approach is associated with a considerable operative risk,and should only be performed at experienced centers.Additional and adjunctive treatment therapies are required to improve the efficacy of this treatment.展开更多
基金programs foundation of Ministry of Education of Liaoning Province,No.202013146
文摘AIM: Several neural and hormonal factors are known to affect motility of sphincter of Oddi (SO). The major roles of SO are to regulate the flow of bile and pancreatic juice into the duodenum and to prevent the reflux of duodenal contents into the biliary and pancreatic duct. After pancreas transplantation, graft SO was denervated and graft pancreatitis might have relations to SO motility. The motilityof SO after canine pancreas transplantation with bladder drainage was investigated. METHODS: Normal canine SO manometry and pancreas graft SO manometry after pancreas transplantation with bladder drainage were performed in seven dogs respectively before and after cholecystokinin (CCK) administration. Data of SO basal pressure, contraction frequency, amplitude and motility index after transplantation and CCK administration were compared with that in controls and before CCK administration.RESULTS: SO showed regular contractions with a certain basal pressure in control dogs. After transplantation, the graft SO basal pressure and contraction frequency were higher than that in controls, but the amplitude decreased (P＜0.01). There was no great difference in SO motility index.CCK administration could relax normal SO but stimulate graft SO after pancreas transplantation with bladder drainage.After CCK administration, SO basal pressure, frequency and motility index were increased significantly (P＜0.05), in comparison with that before administration. The amplitude remained unchanged (P＞0.05), in comparison with that before CCK administration.CONCLUSION: After auto-pancreas transplantation with bladder drainage, canine SO motility was inhibited. Basal pressure and frequency increased but amplitude decreased.CCK administration after transplantation had an inhibitory effect on canine SO instead of a relaxation effect observed in normal canine SO. This will increase the resistance of SO to the pancreatic juice flow and induce pancreatic juice stagnation and can not prevent reflux of urine and duodenal contents when the bladder pressure is increased to a certain extent, which may cause graft pancreatitis.
基金This work is supported by the grant from the National Natural Science Foundation of China(#81570588).
文摘Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor accessibility to the tumor region.Ex vivo surgery followed by intestinal autotransplantation(IATx)is a relatively novel surgical strategy to offer chances for complete resection in such hopeless circumstances.This review aims to assess potential surgical indications,operative techniques and clinical outcomes after IATx.Currently the main indications reported for IATx broadly include pancreatic,mesenteric and retroperitoneal neoplasms closely involving the superior mesenteric vessels.The preliminary results show that radical resection can be effectively achieved in carefully selective patients.Although perioperative morbidity and mortality are relatively high,there are several long-term survivors,particularly after complete resection of benign and low-grade tumor.Early tumor recurrence,however,remains a major problem in patients with high-grade tumor,particularly pancreatic ductal carcinoma.In conclusion,IATx allows patients with selected abdominal neoplasms involving themajormesenteric vessels to be completely resected.However,this aggressive approach is associated with a considerable operative risk,and should only be performed at experienced centers.Additional and adjunctive treatment therapies are required to improve the efficacy of this treatment.
