胰腺移植主要包括单独胰腺移植（pancreas transplantation alone, PTA）、肾移植后胰腺移植（pancreas after kidney transplantation, PAK）和胰肾联合移植（simultaneous pancreaskidney transplantation, SPK）。与其它实体大器官移植一样，胰腺移植成功的真正转折始于20世纪70年代末。随着新型免疫抑制剂的开发和应用、器官保存技术的改进和外科技术的日臻成熟，胰腺移植在全球范围内得到迅猛开展，胰腺移植受体及器官存活率显著提高。据国际胰腺移植登记中心（International Pancreas Transplant Registry, IPTR）记录，至2001年10月，全球已实施17 000余例胰腺移植，其中美国有11 500余例，胰腺移植后患者1年生存率超过95%，3年生存率接近90%； 移植胰腺1年和3年有功能生存率分别为83%和77%［1，2］。自1966年首例SPK在美国Minnesota大学成功实施以来，SPK已成为治疗Ⅰ型糖尿病合并肾功能衰竭的常规方法，全世界迄今为止已实施的胰腺移植中约90%采用该术式［3，4］。
中国的肝脏移植事业在过去10年中取得不菲成绩，在21世纪依然保持蓬勃发展的势头。作为目前治疗肝脏终末期疾病的唯一有效手段，肝脏移植围手术期死亡率已降至5%以下，受体术后1年生存率已超过80%。然而，与国际水准相比，在术后并发症防治方面尚未形成系统化的认识,有待进一步总结经验，从而提高受体生存率和生活质量。其中血管并发症是一个常见和不应忽视的问题。尽管目前外科技术和器官保存技术屡经改良，血管并发症的发生率仍超过10%，尤其是活体部分和劈裂式肝脏移植的血管并发症发生率仍居高不下，其中具有较高死亡率的肝动脉并发症的存在尤为突出，应引起移植外科医师的足够重视并采取有效对策。
临床肝移植始于1963年，1983年美国国家健康委员会对肝移植技术的接受和认可，为全球的肝移植发展注入了活力。目前全球有150余个移植中心，并每年以1万余例的速度开展这项手术，总的手术次数已超过8万例次，最长存活达30余年。与西方国家相比，我国肝移植工作起步晚，发展慢，并曾一度停滞了多年，这与当时的经济状况等因素有关。就早年不多的临床肝移植而言，患者多于术后短期内死亡，这与手术技术的不成熟、有效免疫抑制剂的缺乏、术后管理经验不足等有关。可喜的是，随着近20年来与国外合作交流的增加，许多中青年学者学成后回国，为我国肝移植基础与临床工作的第二次发展奠定了基础。我院肝移植开展于90年代初，近3年来发展迅速，目前已完成了102例。自20世纪90年代以来，肝脏移植在临床上已日渐成为终末期肝病的治疗方法之一，随着外科技术和围手术期管理水平的不断提高，以及各种新型免疫抑制剂的不断开发，肝移植的指征也从早期肝肿瘤扩大到良性终末期肝病，并已成功用于治疗暴发性肝功能衰竭患者。目前，肝移植的手术死亡率在5%以下，1年生存率超过80%，5年生存率在75%左右，患者术后生活质量满意。
We have measured the serum levels of total cholic acid (TCA) in 103 samples of obstructive jaundiced patients (OB group) and 83 samples of gallbladder stone patients without jaundice (control group) by enzymeconjugated colorimetric analysis method. The results revealed that TCA level was higher in OB group than in control group (Plt;0. 001) and had postive correlation with total bilirubin, direct bilirubin and alanine aminotransferase in OB group (Plt;0.01 in all). The clinical value of TCA in obstructive jaundice in comparison with alkaline phosphatase is discussed.
Radioimmunoassay was performed to measure carcinoembryonic antigen (CEA) levels in gastric juice before and after operation in 51 gastric cancer patients (group Ⅰ)， 33 patients with gastric benign lesion (group Ⅱ) and 8 patients with malignant lesion in digestive system other than gastric cancer (group Ⅲ). The results showed that preoperative CEA levels of in group Ⅰ were the highest among three groups (Ｐ＜0.01), but no statistic difference was noted in group Ⅱ and group Ⅲ. In group Ⅰ and group Ⅱ, postoperative CEA levels were higer than the preoperative levels. The authors believe that preoperative CEA measurement of gstric juice is an accessory method in diagnosing gastric cancer, nevertheless, there is no diagnostic significence of postoperative measurement in patient undergone partial gastrectomy.
Objective To observe the inhibitory effects of local co-transfection of tissuetype plasminogen activator(tPA) gene and proliferating cell nuclear antigen antisense oligodeoxynucleotides(PCNA-ASODN) on the intima proliferation and restenosis of autograft artery in rabbits. Methods One hundred and twenty male Zelanian rabbits were randomly divided into four groups(n=30, in each group): control group, PCNA-ASODN group, tPA group and tPA+PCNAASODN group. The left and right external iliac arteries (length 1.0 cm) were transplanted reciprocally. The transplanted arteries were respectively soaked in lipofection, PCNAASODN, pBudCE4.1/tPA and pBudCE4.1/tPA+PCNA-ASODN solution about 15 minutes. The transplanted arteries were sutured with 9-0 sutures soaked in PCNA-ASODN and pBudCE4.1/tPA solution. Each group were divided into five subgroups(n=6, in each subgroup) according to the sacrifice time (3 d, 7 d, 14 d, 28 d and 56 d after operation). On every sacrifice time point, the vascular specimens were harvested. The thrombocyte assembling and thrombus forming lining vessel wall were observed by scanning electron microscope. The pathological morphology of transplanted arteries were observed under microscope(HE). The intimal areas and stenosis ratio(%) of transplanted arteries were calculate and analyzed statistically among groups by computer system. The mRNA expression of tPA gene in transplanted ressel wall was detected with vevere transcriptionPCR(RT-PCR). The number of PCNA positive cells in transplanted vessel wall was counted by SP immunochemisty.Results The mRNA expression of tPA gene in the transplanted vessel wall in tPA and tPA+PCNA-ASODN groups was higher than that of the other two groups(P＜0.01).The number of PCNA positive cells in the transplanted arteries in PCNAASODN, tPA and tPA+PCNAASODN groups were significantly lower than that of control group(P＜0.05，P＜0.01). The intimal areas and degrees of luminal stenosis of PCNAASODN, tPA and tPA+PCNAASODN groups were lower than those of control group(P＜0.05，P＜0.01), and those of tPA＋ PCNA-ASODN group were lower than those of PCNA-ASODN and tPA groups(P＜0.05). Scanning electron microscopy showed that there were a few thrombocytes lining the vessel wall of tPA group and tPA+PCNAASODN group and no thrombus, whereas there were abundant thrombocytes and thrombi lining the vessel wall of the control group. Conclusion Co-transfection of tPA gene and PCNA-ASODN can effectively inhibit the proliferation of VSMC, hyperplasia of intima and restenosis of transplanted artery.