Study of an appropriate volume of jejunectomy to reduce elevated portal pressure after major hepatic resection-aiming at tactics for small-for-size graft in liver transplantation
适当空肠切除体积降低肝大部切除术后门静脉压力升高的研究——针对肝移植中小体积移植物的策略
基本信息
- 批准号:18591424
- 负责人:
- 金额:$ 1.48万
- 依托单位:
- 依托单位国家:日本
- 项目类别:Grant-in-Aid for Scientific Research (C)
- 财政年份:2006
- 资助国家:日本
- 起止时间:2006 至 2007
- 项目状态:已结题
- 来源:
- 关键词:
项目摘要
Portal pressure will be elevated by massive hepatectomy, and induce damage to the remnant liver. The elevated intra-sinusoidal pressure is thought to cause injury of the endothelial cells and hepatocytes. In liver transplantation, a small-for-size graft less than 0.8% of recipient body weight will cause the graft syndrome with hyper-bilirubinemia, elevated liver enzymes, coagulopathy and delayed functional recovery. To solve the portal hypertension, several tactics are issued such as splenic arterial ligation, splenectomy or porto-caval shunting. In addition, liver transplantation surgeons showed dual left lobe graft transplantation, mesocaval shunting, and auxiliary partial orthotopic liver transplantation. About these methods discussions come out with merits and demerits later Therefore, we designed resection of the small intestine and subsequent massive hepatectomy using animals to solve the clinical problem of excessively elevated portal pressure in massive hepatectomy or in small- … More for-size graft liver transplantation. Aiming at an appropriate volume of the jejunectomy to reduce the excessively elevated portal pressure, we designed different sizes of the jejunectomy followed by 80% hepatectomy on rats.MATERIALS & METHODS : Fifteen SD rats were divided into 3 groups, Group A ; performed with only 80% (medial 2 and left lateral lobes plus left caudate lobe) hepatectomy, Group B ; 50% jejunectomy (25% of the small intestine) followed by the hepatectomy, and Group C ; jejunectomy (50% of the small intestine) followed by the same hepatectomy. The ileocolic vein was cannulated with a handmade thin indwelling catheter to measure the portal pressure. The effects of the jejunectomy on portal hypertension induced by the hepatectomy were studied with hemodynamics and histology of the remnant liver concerning congestion and apoptosis.RESULTS : Portal pressure was significantly elevated by 80% hepatectomy in Group A (n=5, 10.24±2.12mmHg), whereas Group B showed the pressure decreased by jejunectomy, then the pressure returned to neutral level after the hepatectomy (n=5,6.21±0.80mmHg). Group C (n=5) showed the suppression of the portal pressure to the lower level (n=5,4.54±2.57mmHg) after the hepatectomy than the standard portal pressure (n=15, 6.61±0.75mmHg)Histology of the remnant liver removed on the day revealed congestion in Group A, but not in Groups B and C. The findings consist of hepatocytic swelling, narrowing of the sinusoidal space, enlargement of the portal area, and dilation of the central vein. These findings of Group A settled down in 1 week, while Groups B and C specimens showed almost normal histology through the week Study of apoptosis in the remnant liver at day 1 and 2 after the hepatectomy showed apoptosic cells in Group A and none in Group B or C.CONCLUSION : 50% jejunectomy (25% resection of the small intestine) can control the portal hypertension induced by massive hepatectomy. And the jejunectomy may prevent the small-far-size graft syndrome in liver transplantation. Less
大量肝切除术会使门静脉压力升高,并对残肝造成损伤。窦内压升高被认为可引起内皮细胞和肝细胞的损伤。在肝移植中,小于受体体重0.8%的小尺寸移植物会引起高胆红素血症、肝酶升高、凝血功能障碍和功能恢复延迟的移植物综合征。为解决门静脉高压症,常用脾动脉结扎术、脾切除术或门静脉分流术。此外,肝移植手术表现为双左叶移植、肠腔分流和辅助部分原位肝移植。因此,我们设计了小肠切除和随后的动物肝大切除术,以解决肝大切除术或小体积肝移植中门静脉压力过高的临床问题。以适当的空肠切除体积为目标,降低过高的门静脉压力,我们设计了不同大小的空肠切除,然后在大鼠肝切除80%。材料与方法:15只SD大鼠分为3组,A组;B组仅行80%(内侧叶、左外侧叶加左尾状叶)肝切除术;50%空肠切除术(25%小肠),然后肝切除术,C组;空肠切除术(小肠的50%)和肝切除术。用手工制作的细管留置导管插管回结肠静脉,测量门静脉压力。通过对肝切除术后残存肝脏的血流动力学和组织学观察,探讨空肠切除术对门静脉高压症的影响。结果:A组经80%肝切除术后门静脉压力显著升高(n=5, 10.24±2.12mmHg),而B组经空肠切除术后门静脉压力下降,肝切除术后门静脉压力恢复到中性水平(n=5,6.21±0.80mmHg)。C组(n=5)肝切除术后门静脉压力低于标准门静脉压力(n=15, 6.61±0.75mmHg) (n=5,4.54±2.57mmHg)。当天切除的残肝组织学显示A组有充血,B、C组无充血,表现为肝细胞肿胀、窦腔狭窄、门静脉面积增大、中心静脉扩张。A组在术后1周内基本稳定,B、C组在术后1、2天的残肝细胞凋亡研究显示,A组有凋亡细胞,B、C组无凋亡细胞。结论:50%空肠切除(25%小肠切除)可控制肝切除术后门静脉高压症。空肠切除术可预防肝移植术后小-远端移植物综合征。少
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Jejunectomy can reduce excessively elevated portal pressure after major hepatectomy in beagle dogs.
空肠切除术可以降低比格犬肝切除术后过度升高的门静脉压力。
- DOI:
- 发表时间:2006
- 期刊:
- 影响因子:0
- 作者:Kawano Y;Akimaru K;Takubo K;et al. (8人中2番目)
- 通讯作者:et al. (8人中2番目)
Is hyperbaric oxygen profitable for the impaired remnant liver after hepatectomy?
高压氧对肝切除术后受损的残肝有益吗?
- DOI:
- 发表时间:2005
- 期刊:
- 影响因子:0
- 作者:Akimaru,K.;Matsuda,N.;Hirakata,A.;Kawano,Y.;Taniai,N.;Mamada,H.;Yoshida,H.;Tajiri,T.
- 通讯作者:Tajiri,T.
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