adrenal autologous tissue implantation

In order to avoid the replacement of Nelson in the Cushing syndrome after adrenal total resection, the prevention of Nelson is caused by the implementation of autologous adrenal tissue transplantation (Hardy Drucker Franksson, 1985) since 1960. This technique has been administered to a small number of cases. However, this method can only be used in the surgical resection process for adrenal gland proliferation, and the adrenal gland tissue selected for cutting must be a normal cell morphology structure, and the scope, time limit, and conditions are strictly limited. For many patients with complete loss of adrenal function due to lesions, such as Addison disease, or early adrenalectomy, or recurrence of symptoms after subtotal resection, there is no condition for autologous implantation. To this end, since the early 1980s, China began to use allogeneic adrenal transplantation to expand surgical indications. After long-term curative effect observation on a group of recipients, it proved that the transplanted gland survived and had physiological functions, and the curative effect was positive. The application value of adrenal allograft was preliminarily established from this clinical practice. At present, adrenal gland transplantation can be divided into two types: one is true allograft transplantation with vascular anastomosis (homotransplantation), the other is also called transplantation, but it is actually autologous adrenal tissue implantation. Autoimplantation. Recently, although autologous transplantation of adrenal tissue with blood vessels has been tried, its clinical value has yet to be further explored and verified. Since Liddle divided the adrenal hyperplasia into Cushing's disease (ie pituitary dependence) and Cushing's syndrome (or may be called primary proliferation) in the 1960s, the choice for surgical treatment seems clearer. . The former is preceded by radiotherapy or surgical resection of pituitary tumor or ectopic dermal progesteroma, the proliferative adrenal gland is not treated, waiting for self-recovery; the latter undergoes bilateral adrenal total resection, and adrenal autologous tissue implantation is applied to such patients. . The non-nodular proliferative zone was selected from the excised adrenal gland, and the near-normal part of the naked eye was sliced. The surgery was implanted in the abdominal muscle of the abdominal incision, allowing the cortical cells to supply nutrients by means of the surrounding tissue to survive. Autonomous secretion of hormones. Because it is implanted with tissue without vascular anastomosis, it is more reasonable to call it "autoimplantation". Treatment of diseases: adrenal tumors Indication Adrenal autologous tissue implantation is suitable for: 1. Patients diagnosed with Cushing syndrome who underwent bilateral adrenal total resection. 2. Although it was diagnosed as Cushing disease, the symptoms were not improved after pituitary radiotherapy or anterior lobe tumor resection (including transsphenoidal microsurgical resection), and the adrenal gland still proliferated and underwent total resection. 3. After Cushing's syndrome, after adrenal subtotal resection, the retained adrenal tissue re-proliferates, the symptoms recur, and must be re-surgically removed. The appearance and quantity of the excised tissue meet the requirements of planting. Such opportunities are rare and can be determined. For relative indications. Contraindications If the resected adrenal gland is covered with proliferative nodules, and the appearance of the adrenal gland is not available in the normal tissue area, it should not be forced to grow. Otherwise, the implant continues to proliferate outside the adrenal gland, and the symptoms must be re-surgically removed. Hemorrhagic or liquefied glandular tissue is also not available for planting and such tissue cannot survive. Preoperative preparation In order to enhance the tolerance of surgery and prevent the rapid in vivo cortisol deficiency that occurs after surgical removal of the gland, adequate preoperative preparation must be given. 1. Give cortisone 50 mg of acetic acid 1 to 2 days before surgery, 4 times a day. In the middle of the subtotal resection of the adrenal gland, intravenous hydroperdazole 100 ~ 200mg, in order to maintain the basic requirements, and continue to the entire surgical procedure. 2. Supply sufficient calories or supplement enough protein by vein. 3. Due to the different degree of sodium retention in the body, it is generally unnecessary to replenish the crystal solution before surgery. If the heart is overloaded, a permeable diuretic can be given as appropriate. Surgical procedure 1. According to the adrenalectomy of adrenal hyperplasia. 2. After removing the fat from the adrenal glands with the surrounding fat, weigh the whole gland. The appearance of no nodules is selected, and the normal glandular tissue area is about 4g. It is cut into 1-2mm slices with a skin graft knife, and the bath is used in Collin liquid or Ringer's solution at 4-8 °C for use. 3. Select the rectus abdominis of the abdominal incision, and excavate the implantation of the adrenal gland in the muscle layer. 4. The cleaned sheet is implanted flatly in the implantation of the rectus abdominis layer, the opening is sutured, the implanted tissue is embedded, the outer part is not removed, and the layers of the abdominal incision are sequentially sutured. complication 1. Continuously instilled cortisol or fluorohydrocortisone 100 mg once daily on the surgery day and within 24 hours after surgery, once/8h. Later, the whole day amount was gradually reduced to 150 mg, 125 mg, 100 mg and maintained at 75 mg. In case of infection or other complications, the dose should be increased as appropriate. Clinical symptoms are the standard for measuring hormone requirements. Symptoms should disappear after surgery and signs will decrease day by day. If the dose is reduced to 75 mg and the dose is still free of hormonal deficiency, it is maintained with dexamethasone and its lifetime maintenance is the same as the daily dose of Addison disease. 2. 6 weeks after the adrenal gland autologous tissue implantation, the hormone can be gradually decreased after the acute phase of hormone deficiency, and the blood, urinary cortex hormone and metabolite content, and the blood ACTH plane can be regularly detected. By the time of pathological biopsy or radionuclide scanning to prove that the implanted cortical cells have survived and have autonomous secretion of hormones, hormone replacement therapy can be completely stopped. The length of the transition period of hormone replacement therapy varies, and the average time of more foreign cases is 31 months. After hormone replacement therapy is asymptomatic, cortisol and its metabolites can reach the low-basic value, and the implant can survive clinically and have the function of secreting cortisol. If pathological biopsy or radionuclide scanning proves that there are endocrine granules in the living cells, and there is the function of phagocytosis of 19 iodine cholesterol, the implant developer can confirm the success of autologous implantation. The hormone secretion of the implant does not show the fluctuation curve of birth rationality, and it is also negative for the ACTH challenge test. This indicates that the hormone secretion function of the implant has reached a high limit.