Wang Da-Dong, Xu Yong, Zhu Zi-Man, Tan Xiang-Long, Tu Yu-Liang, Han Ming-Ming, Tan Jing-Wang
Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
World J Gastroenterol. 2015 Jan 21;21(3):888-96. doi: 10.3748/wjg.v21.i3.888.
To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion (ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs.
Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into the control group (n = 7) and diversion group (n = 7). In the diversion group, portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal pump. After filtration, the blood was returned to the pig through a double-lumen catheter inserted into the internal jugular or subclavian vein. With the conversion pump, portal venous inflow was partially diverted to the inferior vena cava through a catheter inserted via the gastroduodenal vein at 100-130 mL/min. Portal hemodynamics, injury, and regeneration in the liver remnant were compared between the two groups.
Compared to the control group, porta-caval diversion via ECPD significantly mitigated excessive portal venous flow and portal vein pressure (PVP); the portal vein flow (PVF), hepatic artery flow (HAF), and PVP in the two groups were not significantly different at baseline; however, the PVF (431.8 ± 36.6 vs 238.8 ± 29.3, P < 0.01; 210.3 ± 23.4 vs 122.3 ± 20.6, P < 0.01) and PVP (13.8 ± 2.6 vs 8.7 ± 1.4, P < 0.01; 15.6 ± 2.1 vs 10.1 ± 1.3, P < 0.05) in the control group were significantly higher than those in the diversion group, respectively. The HAF in the control group was significantly lower than that in the diversion group at 2 h and 48 h post hepatectomy, and ECPD significantly attenuated injury to the sinusoidal lining and hepatocytes, increased the regeneration index of the liver remnant, and relieved damage that the liver remnant suffered due to endotoxin and bacterial translocation.
ECPD, which can dynamically modulate portal inflow, can reduce injury to the liver remnant and facilitate liver regeneration, and therefore should replace permanent meso/porta-caval shunts in "small-for-size" syndrome.
探讨临时体外持续门腔分流术（ECPD）缓解猪大规模肝切除术后“小肝综合征”门静脉高灌注的可行性。
14头猪接受85%-90%肝切除术，然后随机分为对照组（n = 7）和分流组（n = 7）。在分流组中，通过门静脉导管抽吸门静脉血，进入连接到离心泵的管道。过滤后，血液通过插入颈内静脉或锁骨下静脉的双腔导管返回猪体内。使用转换泵，门静脉血流通过经胃十二指肠静脉插入的导管以100-130 mL/min的速度部分分流至下腔静脉。比较两组肝残余组织的门静脉血流动力学、损伤和再生情况。
与对照组相比，通过ECPD进行门腔分流显著减轻了门静脉血流过多和门静脉压力（PVP）；两组门静脉血流（PVF）、肝动脉血流（HAF）和PVP在基线时无显著差异；然而，对照组的PVF（431.8 ± 36.6 vs 238.8 ± 29.3，P < 0.01；210.3 ± 23.4 vs 122.3 ± 20.6，P < 0.01）和PVP（13.8 ± 2.6 vs 8.7 ± 1.4，P < 0.01；15.6 ± 2.1 vs 10.1 ± 1.3，P < 0.05）分别显著高于分流组。肝切除术后2小时和48小时，对照组的HAF显著低于分流组，ECPD显著减轻了肝血窦内衬和肝细胞的损伤，增加了肝残余组织的再生指数，并缓解了肝残余组织因内毒素和细菌易位而遭受的损伤。
ECPD可动态调节门静脉血流，能减少肝残余组织损伤并促进肝再生，因此在“小肝综合征”中应取代永久性肠系膜/门腔分流术。
