Schadde Erik, Hertl Martin, Breitenstein Stefan, Beck-Schimmer Beatrice, Schläpfer Martin
Institute of Physiology - Center for Integrative Human Physiology, University of Zurich; Department of Surgery, Rush University Medical Center; Department of Surgery, Cantonal Hospital Winterthur;
Department of Surgery, Rush University Medical Center.
J Vis Exp. 2017 Aug 14(126):55895. doi: 10.3791/55895.
Recent clinical data support an aggressive surgical approach to both primary and metastatic liver tumors. For some indications, like colorectal liver metastases, the amount of liver tissue left behind after liver resection has become the main limiting factor of resectability of large or multiple liver tumors. A minimal amount of functional tissue is required to avoid the severe complication of post-hepatectomy liver failure, which has high morbidity and mortality. Inducing liver growth of the prospective remnant prior to resection has become more established in liver surgery, either in the form of portal vein embolization by interventional radiologists or in the form of portal vein ligation several weeks prior to resection. Recently, it was shown that liver regeneration is more extensive and rapid, when the parenchymal transection is added to portal vein ligation in a first stage and then, after only one week of waiting, resection performed in a second stage (Associating Liver Partition and Portal vein ligation for Staged hepatectomy = ALPPS). ALPPS has rapidly become popular across the world, but has been criticized for its high perioperative mortality. The mechanism of accelerated and extensive growth induced by this procedure has not been well understood. Animal models have been developed to explore both the physiological and molecular mechanisms of accelerated liver regeneration in ALPPS. This protocol presents a rat model that allows mechanistic exploration of accelerated regeneration.
近期临床数据支持对原发性和转移性肝肿瘤采取积极的手术方法。对于某些适应证，如结直肠癌肝转移，肝切除术后剩余的肝组织量已成为大的或多发肝肿瘤可切除性的主要限制因素。需要最少数量的功能组织以避免肝切除术后肝衰竭这一严重并发症，其具有高发病率和死亡率。在肝切除术前诱导预期剩余肝脏生长在肝脏手术中已更为成熟，其形式既可以是介入放射科医生进行的门静脉栓塞，也可以是在切除术前几周进行门静脉结扎。最近研究表明，若在第一阶段将实质横断与门静脉结扎相结合，然后仅等待一周后在第二阶段进行切除（联合肝脏分隔和门静脉结扎的分期肝切除术=ALPPS），肝脏再生会更广泛、更迅速。ALPPS已在全球迅速流行，但因其围手术期高死亡率而受到批评。该手术诱导加速和广泛生长的机制尚未得到很好的理解。已建立动物模型来探索ALPPS中加速肝脏再生的生理和分子机制。本方案介绍一种可对加速再生进行机制探索的大鼠模型。
