Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
HPB (Oxford). 2010 Dec;12(10):664-73. doi: 10.1111/j.1477-2574.2010.00229.x. Epub 2010 Nov 8.
Patients with hilar cholangiocarcinoma or hepatolithiasis often develop segmental cholangitis (SC), but it is unclear whether hepatectomy for patients with SC can be performed safely.
Rats were subjected to segmental bile duct ligation (SBDL) with LPS (SC group) or a saline (Sham group) infusion into the bile duct of the ligated lobes. The rats were sacrificed at 3, 24 and 48 h after the SBDL. For another experiment, the rats were subjected to partial hepatectomy (PHx) for the ligated lobes. Hepatic regeneration rates and the expression of regeneration-associated genes were evaluated.
In the SC group, severe parenchymal damage was observed in the acute phase (3 h). Altered gene expression in the liver in response to biliary infection occurred not only in the infected lobes but also in the non-infected lobes. In the rats of the SC group, both the hepatic regeneration rate and serum HGF levels were significantly lower than in the Sham group.
These results clearly demonstrate that SC impairs the regeneration capacity of the contralateral remnant liver. Therefore, hepatectomy should be avoided for patients with SC even if it occurs in the part of the liver to be resected.
肝门部胆管癌或肝胆管结石患者常发生节段性胆管炎（SC），但对于 SC 患者是否可以安全地进行肝切除术尚不清楚。
通过向结扎叶胆管内输注 LPS（SC 组）或生理盐水（Sham 组）对大鼠进行节段性胆管结扎（SBDL）。在 SBDL 后 3、24 和 48 小时处死大鼠。在另一个实验中，对结扎叶进行部分肝切除术（PHx）。评估肝再生率和与再生相关的基因表达。
在 SC 组中，在急性期（3 小时）观察到严重的实质损伤。胆道感染后肝脏基因表达的改变不仅发生在感染叶，也发生在非感染叶。在 SC 组大鼠中，肝再生率和血清 HGF 水平均明显低于 Sham 组。
这些结果清楚地表明，SC 会损害对侧残余肝脏的再生能力。因此，即使 SC 发生在要切除的肝脏部分，也应避免对 SC 患者进行肝切除术。
