Liver volume and function in rat models of regenerative liver surgery

在西方世界，肝切除最常见的原因是结肠和直肠的肝转移。化疗和手术技术的进步增加了可切除肝脏患者的数量。尤其是术前增加肝残余以防止肝切除术后肝衰竭的技术增加了可切除性的限制。然而，门静脉栓塞、门静脉结扎和两期肝切除术等方法受到未来肝残余中度肥大的限制。为了克服这一局限性，“联合肝分区和门静脉结扎分阶段肝切除术”（ALPPS）被提出以扩大可切除性。门静脉结扎和实质横断相结合可在更短的时间内导致更广泛的肥厚。然而，对ALPPS后的结果分析显示，肝切除术后肝衰竭的发生率意外增加。这一观察结果表明，肝容量可能高估了诱导快速肥厚后的肝功能。这个项目的目的是发现，在大鼠模型中，ALPPS或肝切除后的快速肥厚是否与肝功能相对于肝体积的增加不足有关。此外，我们还将探讨结扎后的缓慢肥厚是否也会导致体积和功能的增加不一致。使用Gd-EOB-DTPA （Primovist®）通过MRI测量肝脏体积和功能。在再生手术广泛应用于临床的同时，关于肥大实质功能的关键事实仍然缺失，这一事实强调了该项目的重要性。本项目的目的是通过啮齿动物模型，为临床医生提供关于诱导快速肥厚后肝脏再生功能的基本知识。

Resections of liver metastasis of the colon and rectum are the most common reason for liver resections in the western world. The advances of chemotherapies and surgical techniques have increased the pool of patients with resectable livers. Especially techniques to increase the future liver remnant prior to surgery to prevent post-hepatectomy liver failure increase the limits of resectability.Nevertheless, methods like portal vein embolization, portal vein ligation and two-staged hepatectomies are limited by a moderate hypertrophy of the future liver remnant. To overcome this limitation, “Associating Liver Partition and Portal vein ligation for Staged hepatectomy” (ALPPS) was proposed to expand resectability. The combination of portal vein ligation and parenchymal transection leads to a more extensive hypertrophy in a shorter period of time. However, the analysis of the outcomes after ALPPS demonstrated an unexpected increase in post-hepatectomy liver failure. This observation suggested that liver volume potentially overestimates liver function after induction of a rapid hypertrophy. The aim of this project is to find out, if rapid hypertrophy after ALPPS or an extended liver resection in a rat model, is associated with a lack of an increase of liver function relative to liver volume. Furthermore, it will be investigated, if a slow hypertrophy after portal vein ligation also causes an incongruence of the increase of volume and function or not. Liver volume and function are measured by MRI using Gd-EOB-DTPA (Primovist®).The importance of this project is underlined by the fact, that key facts about functionality of hypertrophied parenchyma is still missing, while regenerative surgery is widely used in clinic. The aim of this project is to provide clinicians with basic knowledge about the functionality of liver regeneration after induction of a rapid hypertrophy by using a rodent model.