Kameoka N, Chijiiwa K, Saiki S, Tanaka M
First Department of Surgery, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Surgery. 1998 May;123(5):545-53. doi: 10.1067/msy.1998.86985.
The purpose of our study was to examine the effect of preoperative portal vein (PV) occlusion on hepatic reserve function after extended hepatectomy that is an excision of areas beyond the PV occluded lobes.
Male Wistar rats were divided into three groups and underwent a two-stage operation: a PVL-hepatectomy group (ligation of the PV [PVL] of the left and median lobes followed by hepatectomy of the right lobes together with the PV occluded lobes), a sham-88% hepatectomy group (sham operation without PVL followed by hepatectomy corresponding to the lobes excised in the PVL-hepatectomy group), and a sham-67% hepatectomy group (sham operation followed by hepatectomy of the left and median lobes to approximate the volume excised in the PVL-hepatectomy group). In all subjects, hepatectomy was carried out 7 days after the PVL or sham operation. On days 0, 1, 2, and 3 after hepatectomy, liver weight, histologic elements, DNA synthesis rates, energy charge, adenine nucleotides, and lipoperoxide levels of the remaining liver were determined.
In the sham-88% hepatectomy group, the volume of resected liver was 88.2% +/- 0.5%. In the PVL-hepatectomy group it was 69.1% +/- 0.8%, although anatomically identical lobes were excised. At the time of hepatectomy, DNA synthesis, hepatic concentrations of adenine nucleotides and lipoperoxide, and serum liver function tests showed similar results in all three groups. The survival rate 3 days after hepatectomy was significantly low (53%) in the sham-88% hepatectomy group, whereas it was 100% in the PVL-hepatectomy and sham-67% hepatectomy groups. The gain in liver weight per day was significantly lower in the sham-88% hepatectomy group than in the other two groups. The decline in hepatic energy charge after hepatectomy was less, with less activated DNA synthesis, in the PVL-hepatectomy group compared with the sham-88% hepatectomy and sham-67% hepatectomy groups. Lipoperoxide concentration in the PVL-hepatectomy group was significantly lower than that in the sham-88% hepatectomy and sham-67% hepatectomy groups.
Preoperative PV occlusion not only increases the remaining liver volume but also is advantageous to hepatic reserve after hepatectomy that exceeds PV occluded lobes.
我们研究的目的是探讨术前门静脉（PV）阻断对扩大肝切除术后肝储备功能的影响，扩大肝切除术是指切除门静脉阻断叶以外的区域。
将雄性Wistar大鼠分为三组，进行两阶段手术：PVL-肝切除组（结扎左叶和中叶的PV [PVL]，然后切除右叶以及PV阻断叶）、假手术-88%肝切除组（未进行PVL的假手术，然后进行与PVL-肝切除组切除叶相对应的肝切除术）和假手术-67%肝切除组（假手术，然后切除左叶和中叶以近似PVL-肝切除组切除的体积）。在所有实验对象中，肝切除术在PVL或假手术后7天进行。在肝切除术后第0、1、2和3天，测定剩余肝脏的重量、组织学成分、DNA合成率、能量电荷、腺嘌呤核苷酸和脂质过氧化物水平。
在假手术-88%肝切除组中，切除肝脏的体积为88.2%±0.5%。在PVL-肝切除组中，尽管切除的是解剖学上相同的叶，但切除体积为69.1%±0.8%。在肝切除时，所有三组的DNA合成、肝脏腺嘌呤核苷酸和脂质过氧化物浓度以及血清肝功能检查结果相似。假手术-88%肝切除组肝切除术后3天的生存率显著较低（53%），而PVL-肝切除组和假手术-67%肝切除组的生存率为100%。假手术-88%肝切除组每天肝脏重量的增加显著低于其他两组。与假手术-88%肝切除组和假手术-67%肝切除组相比，PVL-肝切除组肝切除术后肝脏能量电荷的下降较少，DNA合成激活较少。PVL-肝切除组的脂质过氧化物浓度显著低于假手术-88%肝切除组和假手术-67%肝切除组。
术前PV阻断不仅增加了剩余肝脏体积，而且对超过PV阻断叶的肝切除术后的肝储备有益。
