Bockhorn Maximilian, Benkö Tamasz, Opitz Bettina, Sheu Sien-Yi, Sotiropoulos Georgios C, Schlaak Jörg F, Broelsch Christoph E, Lang Hauke
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Langenbecks Arch Surg. 2008 Jul;393(4):527-33. doi: 10.1007/s00423-007-0219-9. Epub 2007 Sep 12.
In extended liver resections, the preservation of vascular and biliary structures of the entire remnant liver is of paramount importance. The impact of venous outflow impairment and its consequences for liver regeneration and function are still a matter of debate.
Rats (n = 75) were subjected to a 90% partial hepatectomy (PH), to a 70% liver resection with narrowing of the hepatic outflow of an additional 20% parenchyma (70%+ PH) or to an anatomic 70% PH. Postoperatively hepatocyte proliferation (Ki-67), liver function and survival were assessed. Gene expression analysis for markers of regeneration was determined by in-house complementary (DNA) arrays and quantitative real-time polymerase chain reaction (RT-PCR).
Ninety percent PH led to a greater regenerative response as shown Ki-67 compared to animals with a 70%+PH (p < 0.05). However, liver function was equally impaired in both groups. Rats with 70% PH showed a greater proliferation index with less hepatic injury and better liver function. While mortality was 0% in the group of 70% PH, rats with 90% PH and 70+PH had a reduced survival of 75% (p < 0.05)
Venous outflow obstruction leads to an impairment of liver regeneration and liver function. In cases with critically small liver remnants, restoration of an adequate venous outflow may be mandatory.
在扩大肝切除术中，保留整个残余肝脏的血管和胆管结构至关重要。静脉流出道受损的影响及其对肝再生和肝功能的后果仍存在争议。
对75只大鼠进行90%的部分肝切除术（PH）、70%肝切除术并使另外20%实质的肝流出道变窄（70%+PH）或解剖性70%PH。术后评估肝细胞增殖（Ki-67）、肝功能和生存率。通过内部互补（DNA）阵列和定量实时聚合酶链反应（RT-PCR）确定再生标志物的基因表达分析。
与70%+PH的动物相比，90%PH导致更大的再生反应，如Ki-67所示（p<0.05）。然而，两组的肝功能均受到同等程度的损害。70%PH的大鼠增殖指数更高，肝损伤更小，肝功能更好。70%PH组的死亡率为0%，而90%PH和70+PH的大鼠生存率降低至75%（p<0.05）。
静脉流出道梗阻导致肝再生和肝功能受损。在肝残余量极少的情况下，恢复充足静脉流出道可能是必要的。
