Zusammenfassung
GRUNDLAGEN: Die Leberresektion ist eine chirurgisch herausfordernde, aber sicherlich die beste Methode für das Studium der Leberregeneration. Nachdem die Schweineleber eine der humanen Leber vergleichbare Größe, Form und Segmentanatomie hat, wurde eine Technik mit erweiterter Leberresektion und Anlage eines portosystemischen Shunts für das Studium einer Reihe resektionsbedingter Probleme, allen voran der portalen Hyperperfusion, entwickelt. METHODIK: Bei 16 Schweinen wurde eine erweiterte Hemihepatektomie links (etwa 75 % des Lebervolumens) durchgeführt, wobei bei 8 Tieren die Resektion nach Anlage eines portosystemischen H-Shunts zwischen Pfortader und Vena cava erfolgte. Laborproben, Leberbiopsien und Duplexsonografien der Lebergefäße wurden regelmäßig bis zum 8. postoperativen Tag durchgeführt, und die Tiere bis zu ihrem Ableben beobachtet. ERGEBNISSE: Keines der Tiere ist an einer chirurgischen Komplikation verstorben. Obwohl in der Shuntgruppe der Pfortaderfluss reduziert und die arterielle Durchblutung gesteigert war, war die Regeneration der Leber (Restlebervolumen zum Zeitpunkt der Kontrolle / Restlebervolumen nach Resektion) in beiden Gruppen hoch. Nach initialen Leberzellnekrosen zeigten die Biopsien histologisch am Ende der Beobachtungsphase normales Lebergewebe, unabhängig von der Anlage eines Shunts. SCHLUSSFOLGERUNGEN: Diese Technik der erweiterten Leberresektion mit und ohne Anlage eines portosystemischen Shunts ist hilfreich für die Untersuchung der Hämodynamik und der Leberregeneration, insbesondere im Lanzeitverlauf.
Summary
BACKGROUND: Liver resection is an extremely demanding procedure, but is considered the best model for studying liver regeneration. Since the porcine liver has a comparable size, external morphology and segmental anatomy to the human liver, we designed a surgical technique for extended hepatectomy and portosystemic shunt in pigs as a model for the study of various resection-related problems, in particular portal hyperperfusion. METHODS: A seventy-five percent hepatectomy was performed on sixteen pigs, as well as on eight pigs after construction of a side-to-side portocaval H-shunt. Blood samples, liver biopsies and hemodynamic ultrasound examinations were monitored regularly up to day 8 after resection and the animals observed until their death or sacrifice on day 19. RESULTS: None of the pigs died as a result of surgical complications. Although portal blood flow was decreased and arterial flow increased in the pigs with shunt, regeneration rate (remnant liver volume at follow-up/remnant liver volume after surgery) was high in both groups. After initial liver necrosis, survivors showed histologically normal liver tissue around day 19 irrespective of portocaval shunt. CONCLUSIONS: This technique of extended liver resection in the porcine model, with or without portosystemic shunt, may be useful for hemodynamic and liver regeneration studies, in particular for long-term results.
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References
Van Wagensveld BA, Van Gulik TM, Gelderblom HC, Scheepers JJG, Bosma A, Endert E, Gouma DJ (1999) Prolonged continuous or intermittent vascular inflow occlusion during hemihepatectomy in pigs. Ann Surg 3: 376–384
Van Gulik TM, Heijnen BHM (2001) Experimental liver resection. In: Köckerling F, Schwartz SI (eds) Liver surgery, operative techniques and avoidance of complication. Barth, Heidelberg, pp 131–135
Couinaud C (1954) Lobes de segments hepatiques: notes sur l' architecture anatomique et chirurgicale du foie. Presse Med 62: 709–712
Court FG, Wemyss-Holden SA, Morrison CP, Teague BD, Laws PE, Kew J, Dennison A R, Maddern GJ (2003) Segmental nature of the porcine liver and its potential as a model for experimental hepatectomy. Brit J Surg 90: 440–444, doi: 10.1002/bjs.2003.4053
Bismuth H, Dennison AR (1993) Segmental liver resection. Adv Surg 26: 189–208
Kahn D, Hickmann R, Terblanche J, von Sommoggy S (1988) Partial hepatectomy and liver regeneration in pigs – the response to different resection sizes. J Surg Res 45: 176–180
Kawasaki T, Moriyasu F, Kimura T, Someda H, Fukuda Y, Ozawa K (1991) Changes in portal blood flow consequent to partial hepatectomy: Doppler estimation. Radiology 180: 373–377
Fan YD, Praet M, Van Huysse J, Lelie B, De Hemptinne B (2002) Effects of portal vein arterialization on liver regeneration after partial hepatectomy in the rat. Liver Transpl 8: 146–152
Michalopoulos GK, De Frances MC (1997) Liver Regeneration. Science 276: 60–66
Nelson LA, O'Brien DP, Kemp CJ, Williams JL, Dunke-Jacobs E, Erwin CR, Warner BW (2002) Intestinal and hepatic response to combined partial hepatectomy and small bowel resection in mice. Am J Surg 183: 435–440, doi: 10.1016/S0002 – 9610(02)00809-7
Luca A, Cirera I, Pereira O, et al (1991) Normalization of portal pressure following end-to-side portocaval shunt worsens systemic hemodynamic abnormalities in cirrhosis. Hepatology 13: 46
Sekido H, Matsuo K, Takeda K, Morioka D, Kubota T, Tanaka K, Endo I, Togo S, Tanaka K, Shimada H (2002) Severe fatty change of the graft liver caused by a portosystemic shunt of mesenteric varices. Transpl Int 15: 259–262, doi: 10.1007/s00147-002-0409-x
Man K, Lo CM, Ng IO, Wong YC, Qin LF, Fan ST, Wong J (2001) Liver transplantation in rats using small-for-size grafts. A study of hemodynamic and morphological changes. Arch Surg 136: 280–285
Man K, Fan ST, Lo CM, Liu CL, Fung CW, Liang TB, Lee KW, Tsui HT, Ng IO, Zhang ZW, Wong J (2003) Graft injury in relation to graft size in right lobe live donor liver transplantation: a study of hepatic sinusoidal injury in correlation with portal hemodynamics and intragraft gene expression. Ann Surg 237: 256–264
Ueno S, Kobayashi Y, Kurita K, Tanabe G, Aikou T (1995) Effect of prior portosystemic shunt on early hepatic hemodynamics and sinusoids following 84% hepatectomy in dogs. Res Exp Med 195: 1–8
Sahin M, Tekin S, Aksoy F, Vatansev H, Seker M, Avunduk MC, Kartal A (2000) The effects of splenic artery ligation in an experimental model of secondary hypersplenism. J R Coll Surg Edinb 45: 148–152
Troisi R, Cammu G, Militerno G, De Baerdermaeker L, Decruyenaere J, Hoste E, Smeets P, Colle I, Van Vlierberghe H, Petrovic M, Voet D, Mortier E, Hesse UJ, De Hemptinne B (2003) Modulation of portal graft inflow: a necessity in adult living-donor liver transplantation. Ann Surg 237: 429–436
Nishizaki T, Ikegami T, Hiroshige S, Hashimoto K, Uchiyama H, Yoshizumi T, Kishikawa K, Shimada M, Sugimachi K (2001) Small graft for living donor liver transplantation. Ann Surg 233: 575–580
Boillot O, Delafosse B, Mechet I, Boucaud C, Pouyet M (2002) Small-for-size partial liver graft in an adult recipient; a new transplant technique. Lancet 359: 406–407, doi:10.1016/S0140-6736(02)07593-1
Sato Y, Yamamoto S, Oya H, Nakatsuka H, Tsukahara A, Kobayashi Y, Watanabe T, Hatakeyama K (2002) Splenectomy for reduction of excessive portal hypertension after adult living-related donor liver transplantation. Hepatogastroenterology 49: 1652–1655
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Ladurner, R., Bodner, G., Offner, F. et al. Extended hepatic resection and portosystemic shunt in pigs: a model for experimental liver regeneration. Eur Surg 38, 359–363 (2006). https://doi.org/10.1007/s10353-006-0253-9
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DOI: https://doi.org/10.1007/s10353-006-0253-9