Wei Weiwei, Zhang Tianjiao, Zafarnia Sara, Schenk Andrea, Xie Chichi, Kan Chunyi, Dirsch Olaf, Settmacher Utz, Dahmen Uta
Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.
Department of Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany.
Surgery. 2016 May;159(5):1299-307. doi: 10.1016/j.surg.2015.12.005. Epub 2016 Feb 12.
We adapted the anatomically oriented parenchyma-preserving resection technique for associating liver partition with portal vein ligation (PVL) for staged hepatectomy (ALPPS) in rats and examined the role of revascularization in intrahepatic size regulation.
We performed the procedures based on anatomic study. The ALPPS procedure consisted of a 70% PVL (occluding the left median, left lateral, and right lobes), parenchymal transection (median lobe) and partial (10%) hepatectomy (PHx; caudate lobe). The transection effect was evaluated by measuring the extent of hepatic atrophy or regeneration of individual liver lobes in the ALPPS and control groups (70% PVL and 10% PHx without transection). The survival rates after stage II resection and collateral formation within the portal vein system was examined.
Anatomic study revealed a close spatial relationship between the demarcation line and the middle median hepatic vein. This enabled placing the transection plane without injuring the hepatic vein. Transection was achieved via stepwise clamping, followed by 2-3 parenchyma-preserving piercing sutures on both sides of the clamp. Ligated liver lobes atrophy was significantly enhanced after ALPPS compared with the control group. In contrast, both a significantly greater relative weight of the regenerated lobe and proliferation index on the first postoperative day were observed. All animals tolerated stage II-resection without complications. Portoportal collaterals were only observed in the control group.
We developed an anatomically precise technique for parenchymal transection. The lack of a dense vascular network between the portalized and deportalized lobes may play an important role in accelerating regeneration and atrophy augmentation.
我们采用了解剖学导向的实质保留切除术技术，将肝实质分隔与门静脉结扎（PVL）相结合，用于大鼠分期肝切除术（ALPPS），并研究了血管再生在肝内大小调节中的作用。
我们基于解剖学研究进行手术操作。ALPPS手术包括70%门静脉结扎（阻断左中叶、左外侧叶和右叶）、实质横断（中叶）和部分（10%）肝切除术（PHx；尾状叶）。通过测量ALPPS组和对照组（70%门静脉结扎和10%肝切除术但无横断）中各肝叶的肝萎缩或再生程度来评估横断效果。检查了二期切除后的生存率和门静脉系统内的侧支形成情况。
解剖学研究显示，分界线与肝中静脉之间存在密切的空间关系。这使得能够放置横断平面而不损伤肝静脉。通过逐步钳夹实现横断，随后在钳夹两侧进行2 - 3针保留实质的穿刺缝合。与对照组相比，ALPPS术后结扎肝叶的萎缩明显增强。相反，术后第一天再生肝叶的相对重量和增殖指数均显著增加。所有动物均耐受二期切除，无并发症。仅在对照组中观察到门静脉侧支。
我们开发了一种解剖学精确的实质横断技术。门静脉化和非门静脉化肝叶之间缺乏密集的血管网络可能在加速再生和增强萎缩方面起重要作用。
