Analysis of hepatic reserve function after extended hepatectomy and treatment of acute liver failure induced by extended hepatectomy

晚期胆管癌的扩大肝切除术可能导致急性肝功能衰竭，即使患者肝功能正常。术前术后评估肝储备功能，尤其是对肝硬化或梗阻性黄疸患者，对预防术后肝功能衰竭具有重要意义。1.观察了大鼠胆管结扎不同时间段有机阴离子转运体（mrp 2、mrp 3、bsep、oatp和ntcp）mRNA表达的变化。结扎后3 ~ 28天取血和肝组织。从结扎后第3天到第28天，排泄转运蛋白mrp 2和bsep的mRNA水平下降，而mrp 3的mRNA水平上升。摄取转运蛋白ntcp和oatp在结扎后28天开始下降。胆管结扎7天后行胆管内外引流术。mrp 2 mRNA表达水平升高，mrp 3 mRNA表达水平降低。的 ...更多信息 胆管内引流组mrp 2和mrp 3 mRNA表达的改变明显强于胆管外引流组。提示胆道内引流对肝脏储备功能有一定的作用。我们正在检测这些蛋白质水平的表达。2.我们评估了大鼠肝切除术后早期肝脏储备功能和参数的差异，以预测肝衰竭。术后48 h生存率90%组为50%，70%组为100%。90%肝切除术是急性肝功能衰竭的模型。我们测定了大鼠70%或90%肝切除后胆汁流量、胆汁酸排泄量和有机阴离子转运体（mrp 2、mrp 3和bsep）mRNA水平。90%肝切除术后胆汁流量和胆汁酸排出量均明显减少。90%肝切除后胆汁酸排泄量减少，mrp 2表达降低，mrp 3和bsep表达增加。70%肝切除后mrp 2表达增强，mrp 3和bsep表达减弱。mrp 2和mrp 3在70%和90%肝切除后表达有不同程度的变化。我们推测mrp 2和mrp 3的表达以及胆汁酸排泄和胆汁流量可能能够预测扩大肝切除术后的肝功能衰竭。少

Extended hepatectomy for advanced biliary cancer may result in acute liver failure even if in patients with normal liver function. Preoperative and postoperative evaluation of hepatic reserve function especially in patients with liver cirrhosis or obstructive jaundice, to prevent postoperative liver failure, is very important.1.The changes of mRNA expression of the organic anion transporters (mrp2, mrp3, bsep, oatp and ntcp) depending on the duration of bile duct ligation have been examined in rats. Blood and liver tisues were obtained during the period from 3 to 28 days after the ligation. The excretion transporters, the mRNA levels of mrp2 and bsep decreased, while those of mrp3 increased from 3 days until 28 days after the ligation. The uptake transporters, ntcp and oatp decreased until 28 days after the ligation. After 7 days ligation of bile duct, external and internal biliary drainage were performed. The expression of mrp2 mRNA levels increased, while those of mrp3 decreased. The … More se changes of mrp2 and mrp3 mRNA expressions were significantly stronger in the internal biliary drainage than the external drainage. These suggest that the internal biliary drainage is useful for hepatic function reserve. We are now examining the expression of these protein levels.2.We evaluated the differences in hepatic reserve function and parameters to predict the liver failure in the early stage after extended hepatectomy in rats. The survival rates of 48 hours after hepatectomy were 50% in 90% hepatectomy and 100% in 70% hepatectomy. 90% hepatectomy is a model for acute liver failure. We determined the bile flow, biliary bile acid excretion and the mRNA levels of organic anion transporters (mrp2, mrp3 and bsep) after 70% or 90% hepatectomy in rats. The bile flow and bile acid excretion both decreased significantly after the 90% hepatectomy. Biliary bile acid excretion and the expression of mrp2 decreased, while the expressions of mrp3 and bsep increased after 90% hepatectomy. In contrast, the expression of mrp2 increased, while the expressions of mrp3 and bsep decreased after 70% hepatectomy. The expressions of mrp2 and mrp3 were differently regulated after 70% and 90% hepatectomy. We suspected that expressions of mrp2 and mrp3 and biliary bile acid excretion and bile flow might be able to predict the liver failure after extended hepatectomy. Less