联合肝脏离断和门静脉结扎术后大鼠肝储备功能的研究

Experimental study on portal vein ligation combined with in situ splitting on liver functional reserve in rats

目的采用吲哚菁绿（ICG）清除试验评价联合肝脏离断和门静脉结扎术后大鼠肝储备功能。方法将健康清洁雄性SD大鼠75只随机分为3组：假手术组（S组）、单纯门静脉结扎组（PVL组）和联合肝脏离断和门静脉结扎组（ALPPS组），比较PVL组和ALPPS组术后ICG 15 min滞留率（ICGR15），比较各组术后肝再生率、血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、白蛋白（ALB）及总胆红素（TBIL）的变化。结果PVL组和ALPPS组术后各时间右中叶重量均明显增大，且ALPPS组术后第3、7、10、14天明显高于PVL组，分别为[（135.05±6.75）%比（118.15±10.66）%，t＝2.990，P＝0.017、（164.00±6.52）%比（132.59±6.23）%，t＝7.790，P＝0.000、（171.56±9.34）%比（143.39±8.69）%，t＝4.940，P＝0.001、（181.36±14.34）%比（150.68±11.99）%，t＝3.670，P＝0.006]；PVL组和ALPPS组术后第1天血清ALT、AST均急剧升高，且ALPPS组明显高于PVL组，分别为[（817.70±198.10） U/L比（405.60±112.40） U/L，t＝4.050，P＝0.004、（1 472.00±406.20） U/L比（877.50±129.90） U/L，t＝3.120，P＝0.014]。两组术后第1、3天ALB浓度均明显降低，且ALPPS组明显低于PVL组，为[（25.44±1.71） μmol/L比（31.42±1.51） μmol/L，t＝5.860，P＝0.000、（25.00±1.96） μmol/L比（30.76±1.49） μmol/L，t＝5.230，P＝0.000]。两组术后血清TBIL水平差异无统计学意义；术后第7、10、14天，PVL组和ALPPS组ICGR15均降低，两组间差异无统计学意义（P〈0.05）。结论联合肝脏离断和门静脉结扎术显著促进了肝脏再生，但肝储备功能并不伴随着相应地快速提升。

ObjectiveTo evaluate liver functional reserve of rats in associating liver partition with portal vein ligation using indocyanine green （ICG） clearance test.MethodsSeventy-five healthy male Sprague-Dawley rats were selected and randomly assigned into three groups： sham operation group （S）, portal vein ligation group （PVL）, associating liver partition with portal vein ligation group （ALPPS）, and then the ICGR15 was detected postoperatively at each observation time point in group PVL and group ALPPS. The hepatic regeneration rate （HRR） of the right median lobe, serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, albumin （ALB）, total bilirubin （TBIL） were compared at each observation time point.ResultsThe HRR of the right median lobe was obviously increased at each set time point in PVL group and ALPPS group, and the HRR in group ALPPS was significantly higher than that in group PVL [（135.05±6.75）% vs. （118.15±10.66）%, t=2.990, P=0.017, （164.00±6.52）% vs. （132.59±6.23）%, t=7.790, P=0.000, （171.56±9.34）% vs. （143.39±8.69）%, t=4.940, P=0.001, （181.36±14.34）% vs. （150.68±11.99）%, t=3.670, P=0.006]; The serum ALT and AST increased obviously on day 1, and the serum ALT and AST in group ALPPS was significantly higher than in group PVL on day 1 [（817.70±198.10） U/L vs. （405.60±112.40） U/L, t=4.050, P=0.004, （1 472.00±406.20） U/L vs. （877.50±129.90） U/L, t=3.120, P=0.014]. The serum ALB decreased obviously on day 1and 3, and group ALPPS was significantly lower than in group PVL [（25.44±1.71） μmol/L vs. （31.42±1.51） μmol/L, t=5.860, P=0.000, （25.00±1.96） μmol/L vs. （30.76±1.49） μmol/L, t=5.230, P=0.000]. There were no significant differences in serum TBIL at each time point; The serum ICGR15 was decreased in PVL group and ALPPS group on day 7, 10 and 14, there were no significant differences between two groups （P〉0.05）.ConclusionAssociating liver partition with portal vein ligation could significantly accelerate liver regeneration, but the liver functional reserve didn’t increase accordingly.