大鼠ALPPS模型的建立

Establishment of a rat model:Associating liver partition and portal vein ligation for hepatectomy(ALPPS)

目的建立一种可复制的大鼠ALPPS模型。方法使用SD大鼠建立可复制的ALPPS实验模型,ALPPS技术操作包括:肝脏右外侧叶,左外侧叶及左中叶门静脉支结扎(70%PVL),尾状叶切除(10%肝脏部分切除)和左右中叶间肝实质的80%离断,将右中叶作为未来残余肝(FLR),占全肝体积20%;门静脉结扎组,只行相应肝叶的门静脉支结扎和尾状叶的切除,不进行肝实质离断;对照组,仅行肝蒂的解剖分离和尾状叶的切除。于术后24小时,48小时及96小时时相点分析大鼠体重变化和FLR的再生能力;另外一组于ALPPSⅠ期操作后的96小时完成ALPPSⅡ期手术,检验扩大的肝脏切除术的可行性及安全性。结果 5只大鼠于术后第二天死亡,主要死因是出血和腹水。术后24小时和48小时时间点:ALPPS组、PVL组和对照组间的体重变化差异不具有显著性,P值均大于0.05。术后96小时时间点:ALPPS组和PVL组的体重变化与对照组相比,差异具有显著性,P值均小于0.05,但ALPPS组和PVL组的体重变化相比,差异不具有显著性,P值大于0.05。术后24小时:ALPPS组、PVL组和对照组间的FLR再生率差异不具有显著性,P值均大于0.05。术后48小时时间点:ALPPS组和PVL组的FLR再生率明显升高,与对照组相比,差异具有显著性,P值均小于0.05,但ALPPS组和PVL组的FLR再生率相比,差异不具有显著性,P值大于0.05。术后96小时时间点:三组FLR再生率相比,差异具有显著性,P值均小于0.05,且ALPPS组FLR再生率明显高于PVL组。另外一组6只大鼠行ALPPSⅠ期手术后4天接受Ⅱ期手术,全部存活直到术后7天人为处死。结论我们成功地建立了大鼠可复制的ALPPS实验模型,达到了预期效果。

Objective The aim was to develop a reproducible rat model of ALPPS.Methods To establish a rat model of ALPPS,a total of 66 sprague-Dawley rats were used.ALPPS procedure consisted of portal vein ligation（right lateral lobes,median lobe and left lateral lobe）,partial hepatectomy（caudate lobectomy）and parenchymal transection（median lobes）;PVL group were subjected to portal vein ligation of responding lobes without parenchymal split,and caudate lobectomy.Sham group procedure performed only caudate lobectomy and portal vein dissection.Sacrifice at 24 h,48 h and 96 hafter the procedure was performed.The weight change and regeneration rate of FLR（right median lobe）were analyzed.An additional group of 6 rats underwent extended liver resection at 4 days after ALPPSⅠstage to examine the safety and feasibility for ALPPS stageⅡ,survive 7 days until artificial sacrifice.Results 5 rats died from bleeding or/and ascite in ALPPS group at 2 days after operation.Weight change had no statistically differences among ALPPS group,PVL group and sham group,P〈0.05,respectively in 24 hand 48 htime-point.But in 96 htime-point,compared to sham group,the weight change in ALPPS group and PLV group,had statistically significant difference,P〈0.05,respectively,and had no statistic significance difference between ALPPS group and PVL group,P〈0.05.Regeneration Rate of FLR had no statistically differences among ALPPS group,PVL group and sham group,P〈0.05,respectively in 24 htime-point.In 48 htime-point：Compared to sham group,the regenerate rate of FLR in ALPPS group and PLV group,had statistically significant difference,P〈0.05,respectively,and the rate had no statistic significance difference between ALPPS group and PVL group,P〈0.05.In 96 htime-point,the generate rate of FLR in ALPPS group were higher than other groups,and had statistics significance,P〈0.05.The additional group of 6 rats underwent successfully ALPPSⅠstage andⅡ stage procedure,survive 7 days until artificial sacrifice.Conclusion we successfully establish a reproducible experimental ALPPS model of rat,achieving the expected results.