间置性门腔分流术对安全最小肝残存量的影响：猪模型。
Impact of mesocaval shunt on safe minimal liver remnant: porcine model.
机构信息
Department of Hepatobiliary Surgery, the First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China.
出版信息
World J Gastroenterol. 2013 Aug 21;19(31):5076-84. doi: 10.3748/wjg.v19.i31.5076.
AIM
To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.
METHODS
A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occlusion was performed. The mesenteric venous inflow was diverted through a mesocaval shunt (MCS) constructed using the prepared left renal vein with an end-to-side running suture of 5-0 proline. All 21 animals that underwent subtotal hepatectomy and/or MCS were divided into three groups. In the 15% group, the residual volume was 14%-19% of total liver volume (TLV); in the 15%+ S group, the residual volume was also 14%-19% of TLV with a mesocaval shunt (MCS); and in the 10%+ S group, the residual volume was 8%-13% of TLV with an MCS. In the three groups, the intraoperative portal vein pressure (PVP) and portal vein flow (PVF) were monitored and compared at laparotomy and 1 h post-hepatectomy. The survival rate, sinusoidal endothelial damage, tissue analysis, and serum analysis were investigated among the three groups.
RESULTS
The percentage residual liver volume was 15.9%, 16.1% and 11.8% in the 15%, 15%+ S, 10%+ S groups, respectively. After hepatectomy, PVF and portal-to-arterial flow ratio in the 15%+ S group significantly decreased and hepatic artery flow (HAF) per unit volume significantly increased, compared to those in the 15% group. The PVP in the 15%+ S group and 10%+ S group increased slightly from that measured at laparotomy; however, in the 15% group, the PVP increased immediately and significantly above that observed in the other two groups. The 14-d survival rates were 28.5%, 85.6%, and 14.2% in the 15%, 15%+ S, and 10%+ S groups, respectively. In the 15%+ S group, the shunts effectively attenuated injury to the sinusoidal endothelium, and the changes in the serum and tissue analysis results were significantly reduced compared to those in the 15% and 10%+ S groups.
CONCLUSION
MCS can decompress the portal vein and so attenuate liver injury from hyperperfusion, and make extreme or marginal hepatectomy safer.
目的
研究分流术缓解门脉高压和减少猪安全肝残余量的能力。
方法
采用<60ml 出血量和不阻断肝蒂的半肝切除术。肠系膜静脉流入通过使用准备好的左肾静脉进行侧侧吻合的肠系膜腔静脉分流术（MCS）进行分流，使用 5-0 脯氨酸进行连续缝合。所有接受半肝切除术和/或 MCS 的 21 只动物分为三组。在 15%组中，残余肝体积为总肝体积（TLV）的 14%-19%；在 15%+S 组中，残余肝体积也为 TLV 的 14%-19%，同时行 MCS；在 10%+S 组中，残余肝体积为 TLV 的 8%-13%，同时行 MCS。在三组中，在剖腹手术时和肝切除术后 1 小时监测和比较门静脉压力（PVP）和门静脉流量（PVF）。研究三组的生存率、窦内皮损伤、组织分析和血清分析。
结果
15%、15%+S、10%+S 组的残余肝体积百分比分别为 15.9%、16.1%和 11.8%。肝切除后，15%+S 组的 PVF 和门静脉-动脉血流比明显下降，单位体积肝动脉血流（HAF）明显增加，与 15%组相比。15%+S 组和 10%+S 组的 PVP 较剖腹手术时略有升高，但 15%组的 PVP立即显著升高，高于其他两组。15%、15%+S 和 10%+S 组的 14 天生存率分别为 28.5%、85.6%和 14.2%。15%+S 组分流术有效减轻了窦内皮损伤，与 15%和 10%+S 组相比，血清和组织分析结果的变化明显减轻。
结论
MCS 可降低门静脉压力，从而减轻肝灌注过度引起的肝损伤，使极端或边缘性肝切除术更安全。
Zotero 插件