Department of Surgery, Transplantation and Gastroenterology, Hepato-Pancreatico-Biliary Surgical Research Center, Semmelweis University, Ulloi Street 78, 1082, Budapest, Hungary.
Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
Sci Rep. 2022 Nov 14;12(1):19441. doi: 10.1038/s41598-022-23744-2.
Aiming to improve the postoperative outcome of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), the effect of physical prehabilitation (PP) was investigated in experimental model. Male Wistar rats (n = 106) divided to PP and sedentary (S) groups underwent ALPPS. Changes in liver weight, Ki67 index and liver volume by magnetic resonance imaging (MRI) were evaluated. Liver function was assessed by laboratory parameters and Tc-mebrofenin single-photon emission computed tomography (SPECT) hepatobiliary scintigraphy (HBS). Utilizing endotoxemia model mortality and septic parameters were investigated. Liver mass (p < 0.001), Ki67 index (p < 0.001) and MRI liver volume (p < 0.05) increased in the PP group compared to the S group. Both standard laboratory parameters (p < 0.001) and HBS (p < 0.05) showed enhanced liver function in the PP group compared to the S group. The vulnerability of animals improved in the PP group, as mortality decreased (p < 0.001), while septic laboratory parameters improved (p < 0.05) compared to the S group in the endotoxemia model. Our study demonstrated for the first time the beneficial role of PP on not only volumetric but also functional liver regeneration and postoperative vulnerability after ALLPS.
为了改善联合肝脏分隔和门静脉结扎分阶段肝切除术（ALPPS）的术后效果，研究了物理预康复（PP）在实验模型中的作用。雄性 Wistar 大鼠（n=106）分为 PP 组和久坐（S）组，进行 ALPPS。通过磁共振成像（MRI）评估肝重、Ki67 指数和肝体积的变化。通过实验室参数和 Tc-美罗芬尼单光子发射计算机断层扫描（SPECT）肝胆闪烁扫描（HBS）评估肝功能。利用内毒素血症模型研究死亡率和脓毒症参数。与 S 组相比，PP 组的肝质量（p<0.001）、Ki67 指数（p<0.001）和 MRI 肝体积（p<0.05）增加。与 S 组相比，PP 组的标准实验室参数（p<0.001）和 HBS（p<0.05）均显示出增强的肝功能。PP 组动物的脆弱性改善，死亡率降低（p<0.001），而内毒素血症模型中脓毒症实验室参数改善（p<0.05）。我们的研究首次证明了 PP 不仅对体积而且对术后 ALPPS 后的功能性肝再生和术后脆弱性具有有益作用。
