Liver volume and function in rat models of regenerative liver surgery

在西方，切除结肠和直肠的肝转移瘤是肝切除最常见的原因。化疗和外科技术的进步增加了可切除肝脏的患者数量。尤其是术前增加未来残肝的技术，以防止肝切除术后肝功能衰竭，增加了可切除性的限度。然而，门静脉栓塞术、门静脉结扎和二期肝切除术等方法受到未来残肝中度肥大的限制。为了克服这一局限性，提出了“联合肝分割和门静脉结扎分期肝切除”(ALPPS)以扩大可切除性。门静脉结扎与肝实质横断术相结合，可在较短时间内形成更大范围的肥厚。然而，对ALPPS术后结果的分析显示，肝切除术后肝功能衰竭的发生率意外增加。这一观察表明，在诱导快速肥大后，肝脏体积可能高估了肝功能。该项目的目的是找出，在大鼠模型中，ALPPS后快速肥大或扩大肝切除是否与肝功能相对于肝脏体积缺乏增加有关。此外，还将研究门静脉结扎后缓慢肥大是否也会导致体积和功能的增加不一致。肝脏体积和功能的MRI测量使用Gd-EOB-DTPA(Primovist®)。该项目的重要性在于，关于肥大的实质功能的关键事实仍然缺乏，而再生手术在临床上得到了广泛的应用。这个项目的目的是为临床医生提供有关利用啮齿动物模型诱导快速肥大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.