Shi J H, Hammarström C, Grzyb K, Line P D
Department of Hepatobiliary and Pancreatic Surgery The First Affiliated Hospital of Zhengzhou University, Zhengzhou University Zhengzhou China.
Department of Transplantation Medicine Oslo University Hospital, Rikshospitalet Oslo Norway.
BJS Open. 2017 Oct 24;1(3):84-96. doi: 10.1002/bjs5.18. eCollection 2017 Jun.
The underlying mechanism of liver regeneration after Associating Liver Partition and Portal vein ligation (PVL) for Staged hepatectomy (ALPPS) is still unclear. The aim of this study was to evaluate the relationship between future liver remnant (FLR) volume, liver regeneration characteristics and restoration of function in an experimental model of ALPPS.
An ALPPS model in rats was developed with selective PVL, parenchymal transection and partial hepatectomy (step 1), followed by resection of the liver (step 2). Three different ALPPS groups with FLR sizes of 30, 20 and 10 per cent of total liver volume were compared with sham-operated controls and animals undergoing resection of left lateral lobe and 90 per cent PVL with respect to morbidity, mortality, liver regeneration and function.
Three of 15 animals that had ALPPS with 10 per cent FLR (ALPPS10) died after step 1. Ascites developed in two of five rats that had ALPPS with 20 per cent FLR and in three of four animals in the ALPPS10 group after step 2. Although the relative increments in FLR size and growth rates were highest in the ALPPS groups, small FLR size was associated with a sustained increase in levels of serum aminotransferases and bilirubin, a lower albumin concentration, severe sinusoidal injury, increased expression of proliferation markers and increased activation of hepatic progenitor cells after step 2.
There is discordance between FLR volume increase and functional restoration after the ALPPS procedure.
联合肝脏分隔和门静脉结扎的分期肝切除术（ALPPS）后肝脏再生的潜在机制仍不清楚。本研究的目的是在ALPPS实验模型中评估未来肝残余（FLR）体积、肝脏再生特征与功能恢复之间的关系。
通过选择性门静脉结扎、实质横断和部分肝切除术（步骤1）建立大鼠ALPPS模型，随后切除肝脏（步骤2）。将FLR大小分别为全肝体积30%、20%和10%的三个不同ALPPS组与假手术对照组以及接受左外叶切除和90%门静脉结扎的动物在发病率、死亡率、肝脏再生和功能方面进行比较。
15只接受10% FLR的ALPPS动物（ALPPS10）中有3只在步骤1后死亡。在步骤2后，5只接受20% FLR的ALPPS大鼠中有2只出现腹水，ALPPS10组的4只动物中有3只出现腹水。尽管ALPPS组中FLR大小的相对增加和生长速率最高，但较小的FLR大小与步骤2后血清转氨酶和胆红素水平持续升高、白蛋白浓度降低、严重的肝血窦损伤、增殖标志物表达增加以及肝祖细胞激活增加有关。
ALPPS手术后FLR体积增加与功能恢复之间存在不一致。
