The mechanism of liver regeneration after portal lmbolization and the effect of transforming growth factor alpha to liver regeneration

术前行门静脉栓塞13例，其中胆管癌6例，转移性肝癌3例，肝癌1例，胆囊癌1例，胆管囊腺癌1例，胆管癌1例。12例无纤维化，1例非癌性病变伴慢性肝炎。在经回肠结肠门静脉栓塞术中，在开腹时经回肠结肠静脉将导管插入门静脉。栓塞材料为明胶泡粉2g、凝血酶10000单位、阿米卡星200mg的混合物。采用酶联免疫吸附扩散法（ELISA）检测血清tgf - α水平。分别于门静脉栓塞术前及术后第1、2、3、5、7、14、21天采血。术中取肝切除术前右（栓塞）叶和左（未栓塞）叶楔形活检标本。使用单克隆抗体pc10免疫组化检测增殖细胞核抗原（PCNA）表达后，每切片检测1000个肝细胞，标记指数（LI）定义为每1000个肝细胞中PCNA阳性细胞的数量。所有病例术后肝功能均有轻微改变。11例血清tgf - α值出现两个峰值。在术后第1 ~ 3天达到第一个峰值，在术后第14 ~ 21天达到第二个峰值。5例未栓塞肺叶的LI明显高于栓塞肺叶。

Preoperative portal embolization was performed in 13 patients (6 with bile duct cancer, 3 with metastatic liver tumor, 1 with hepatocellular carcinoma, 1 with gall bladder carcinoma, 1 with bile duct cystadenocarcinoma and 1 with cholangio carcinoma. Twelve cases were no fibrosis and one case was chronic hepatitis in non cancerous lesion. In transileocolic portal embolization the catheter was inserted into the portal vein at laparotomy through the ileocolic vein. The embolization material consisted of a mixture of 2g Gelfoam powder, 10000 units of thrombin, and 200 mg of Amikacin. Serum TGF-alpha levels were measured by enzyme-linked immunosorbent diffusion assay (ELISA). Blood was collected before portal embolization and on days 1, 2, 3, 5, 7, 14 and 21 after surgery from patients who underwent portal embolization. Wedge biopsy specimens were obtained intraoperatively from the right (embolized) and left (non embolized) lobes before hepatic resection. After expression of proliferative cell nuclear antigen (PCNA) was detected immunohistochemically using the monoclonal antibody PC 10, 1000 hepatocytes per section were examined and the labeling index (LI) was defined as the number of PCNA-positive cells per 1000 hepatocytes. All cases had a little change of liver function after PE.Serum TGF-alpha values in eleven cases show two peaks. The values reached the first peak levels on postoperative day 1 to day 3 and the second peak levels on postoperative day 14 to 21. The LI for nonembolized lobe in five cases were significantly higher than those for the embolized lobe.