Jo Hye-Sung, Park Hyun-Jin, Choi Yoon Young, Seok Jin-I, Han Jae-Hyun, Yoon Young-In, Kim Dong-Sik
Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine Seoul, Korea.
Department of Biomedical Science, Korea University College of Medicine Graduate School Seoul, Korea.
Am J Transl Res. 2021 Jun 15;13(6):5880-5891. eCollection 2021.
Excessive postoperative portal pressure is associated with post-hepatectomy liver failure and small-for-size syndrome after partial liver transplantation. This study aimed to identify the portal modulation effects of terlipressin on liver regeneration and survival in a porcine model subjected to 90% hepatectomy.
Twenty pigs undergoing 90% hepatectomy were divided into control (n = 10) and terlipressin (n = 10) groups. Terlipressin 0.5 mg was injected subcutaneously three times a day, from immediately before hepatectomy to 7 days after surgery, for surviving pigs in the terlipressin group. Portal pressure measurement, biochemical analysis, assessment of molecular markers for liver regeneration, and immunohistochemistry were performed in both groups.
The 7-day survival rate was significantly higher in the terlipressin group than that in the control group. Portal pressure in the terlipressin group was lower than that in the control group at 30 min and 1 h after hepatectomy. Total bilirubin level was lower in the terlipressin group than that in the control group at 1 h and 6 h after hepatectomy. Proliferating cell nuclear antigen expression was higher in the control group than that in the terlipressin group at 6 h after hepatectomy, while the proportion of Ki-67-positive cells was higher in the terlipressin group than that in the control group at 7 days after hepatectomy. Endothelin-1 level reflecting liver injury was lower in the terlipressin group than that in the control group at 1 h and 6 h after hepatectomy.
Terlipressin could optimize liver regeneration and improve survival through rapid and effective portal modulation after extensive hepatectomy.
术后门静脉压力过高与肝部分切除术后肝衰竭及小肝综合征相关。本研究旨在确定特利加压素对接受90%肝切除术的猪模型肝脏再生及存活的门静脉调节作用。
20头接受90%肝切除术的猪被分为对照组（n = 10）和特利加压素组（n = 10）。特利加压素组存活猪从肝切除术前即刻至术后7天，每天皮下注射0.5 mg特利加压素三次。两组均进行门静脉压力测量、生化分析、肝脏再生分子标志物评估及免疫组织化学检测。
特利加压素组7天生存率显著高于对照组。肝切除术后30分钟和1小时，特利加压素组门静脉压力低于对照组。肝切除术后1小时和6小时，特利加压素组总胆红素水平低于对照组。肝切除术后6小时，对照组增殖细胞核抗原表达高于特利加压素组，而肝切除术后7天，特利加压素组Ki-67阳性细胞比例高于对照组。反映肝损伤的内皮素-1水平在肝切除术后1小时和6小时，特利加压素组低于对照组。
特利加压素可通过广泛肝切除术后快速有效的门静脉调节优化肝脏再生并提高生存率。
