Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
J Invest Surg. 2022 Mar;35(3):549-559. doi: 10.1080/08941939.2021.1894517. Epub 2021 Mar 17.
Portal vein (PV) embolization is performed prior to extended hepatectomy for the damaged liver to increase future remnant liver volume and prevent postoperative liver failure. This study examined whether two-stage PV ligation (PVL) increased regeneration and hypertrophy of the future remnant liver compared to conventional PVL, and whether two-stage PVL was safe for damaged liver.
We produced a cirrhotic liver rat model with perioperatively maintained fibrosis. Rats were divided into: Group A (70%PVL), ligation of left branch of PV; Group B (90%PVL), ligation of right and left branches of PV; and Group C (two-stage 90%PVL), two-stage PVL with left branch ligation of PV followed by right branch ligation 7 days later. To evaluate liver regeneration, liver weight ratios, proliferating cell nuclear antigen (PCNA) labeling index (LI), mitotic index (MI), and TdT-mediated dUTP-biotin nick end labeling (TUNEL) LI in the non-ligated caudate lobe were measured.
Fourteen-day survival rate was 20% in Group B but 100% in Group C. TUNEL LI differed significantly between Groups A and B at 2 and 7 days postoperatively. Weight ratios were significantly higher in Group C than in Groups A and B at 14 days postoperatively. PCNA LI and MI in the non-ligated caudate lobe decreased to preoperative levels by 7 days postoperatively in Groups A and B, but remained elevated until 14 days postoperatively in Group C.
In cirrhotic liver rats, two-stage PVL avoided the lethal liver failure seen with one-stage PVL, and significantly facilitated liver regeneration more than one-stage PVL.
门静脉（PV）栓塞术在扩大肝切除术前进行，以增加剩余肝体积并预防术后肝功能衰竭。本研究检查了两阶段 PV 结扎（PVL）是否比常规 PVL 更能促进剩余肝的再生和肥大，以及两阶段 PVL 是否对受损的肝脏安全。
我们通过围手术期维持纤维化的方法制作了一个肝硬化大鼠模型。大鼠分为：A 组（70%PVL），结扎左支 PV；B 组（90%PVL），结扎右支和左支 PV；C 组（两阶段 90%PVL），两阶段 PVL，先结扎左支 PV，7 天后再结扎右支 PV。为了评估肝再生，测量未结扎尾叶的肝重比、增殖细胞核抗原（PCNA）标记指数（LI）、有丝分裂指数（MI）和末端转移酶介导的 dUTP-生物素缺口末端标记（TUNEL）LI。
B 组的 14 天存活率为 20%，而 C 组为 100%。术后 2 天和 7 天，A 组和 B 组之间 TUNEL LI 差异显著。术后 14 天，C 组的肝重比明显高于 A 组和 B 组。术后 7 天，A 组和 B 组的非结扎尾叶 PCNA LI 和 MI 恢复到术前水平，但 C 组直到术后 14 天仍保持升高。
在肝硬化大鼠中，两阶段 PVL 避免了一阶段 PVL 引起的致命性肝功能衰竭，并比一阶段 PVL 更显著地促进了肝再生。
