目的:联合肝分区和门静脉结扎(PVL)进行分期肝切除术(ALPPS)是扩大未来肝残存量(FLR)和提高肿瘤可切除率的创造性策略。然而,当FLR过小时,ALPPS的适应症必须有一定的限制。我们旨在建立一种改良的ALPPS模型,在大鼠中具有更广泛的适用性。
方法:在仅具有6.5%FLR的啮齿动物中建立了极端ALPPS模型。门静脉(PV)受到不同程度的限制,然后测量门静脉压力(PVP)。然后,ALPPS的不同修饰,包括肝动脉限制(HAR),逐渐门静脉限制(GPVR),和GPVR相关的HAR(HAR+GPVR),应用于极端ALPPS模型。
结果:PVL或PVR引起PVP立即增加。PVR中的PVP-1.28mm,PVR-0.81mm,PVR-0.63mm,PVL组为11.05±1.57cmH2O,16.18±1.92cmH2O,20.66±1.99cmH2O,和24.10±3.33cmH2O,分别,相应的3天生存率为100%,90.09%,分别为36.33%和0。然后,在极端的ALPPS模型中,对照中FLR的生长比率,HAR,GPVR,HAR+GPVR组为0.43±0.21、0.50±0.16、4.80±0.86和7.40±2.56,因此,相应的30天生存率为9.09%,15.38%,84.61%和92.90%,分别。
结论:ALPPS本身有一个限制,在极端ALPPS模子中,PVL后高PVP有助于术后逝世亡。此外,提出了一种极端ALPPS的改进方法,即,GPVR+HAR代替PVL,显著提高了大鼠肝切除模型的生存率。
OBJECTIVE: Associating liver partition and portal vein ligation (PVL) for staged hepatectomy (
ALPPS) is a creative strategy for enlarging the future liver remnant (FLR) and increasing the tumor resectability rate. However, the indications for
ALPPS must have a certain limit when the FLR is too small. We aimed to establish a modified
ALPPS model with more widen applicability in rats.
METHODS: An extreme
ALPPS model was established in rodents with only a 6.5% FLR. The portal vein (PV) was subjected to restriction to different degrees, then the portal vein pressure (PVP) was measured. Then, different modifications of ALPPS, including hepatic artery restriction (HAR), gradual portal vein restriction (GPVR), and GPVR-associated HAR (HAR+GPVR), were applied in the extreme ALPPS models.
RESULTS: PVL or PVR provoked an immediate increase in the PVP. The PVP in the PVR -1.28 mm, PVR -0.81 mm, PVR -0.63 mm, and PVL groups was 11.05±1.57 cmH2O, 16.18±1.92 cmH2O, 20.66±1.99 cmH2O, and 24.10±3.33 cmH2O, respectively, and the corresponding 3-day survival rate was 100%, 90.09%, 36.33% and 0, respectively. Then, in the extreme ALPPS model, the growth ratio of the FLR in the control, HAR, GPVR, and HAR+GPVR groups was 0.43±0.21, 0.50±0.16, 4.80±0.86, and 7.40±2.56, and as a consequence, the corresponding 30-day survival rate was 9.09%, 15.38%, 84.61% and 92.90%, respectively.
CONCLUSIONS: ALPPS itself has a limit, and high PVP after PVL contributes to postoperative death in the extreme
ALPPS model. Furthermore, a modified method for extreme ALPPS is proposed, i.e., GPVR+HAR in place of PVL, which significantly improves the survival rate of extreme hepatectomy in rat models.