ObjectiveTo summarize the progress of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and evolution of surgical procedure improvement, so as to summarize experience in selecting appropriate surgical method for patients. MethodThe domestic and foreign literature on the evolution of ALPPS surgical procedure improvement in recent years was reviewed. ResultsIn the decade since the emergence of ALPPS, the ALPPS had been rapidly developed in the hepatobiliary surgery. The ALPPS promoted a rapid increase in future liver remnant during a relatively shorter period to contribute to resectability of liver tumors and reduce the rate of postoperative liver failure, the patients with intermediate to advanced and huge liver cancer could obtain the surgical radical resection. In recent years, the domestic and foreign experts had refined the ALPPS procedure, which mainly focused on the operation of hepatic section separation and hepatic artery flow restriction in stage Ⅰ surgery, including partial ALPPS, radiofrequency ablation ALPPS, tourniquet ALPPS, transcatheter arterial embolization ALPPS, hepatic artery ringed and operation ALPPS, as well as laparoscopic ALPPS and robotic ALPPS with minimally invasive approach. ConclusionsDespite the ongoing controversy over ALPPS, with the continuous progress and innovation of improved procedures and the utilization of laparoscope and robot in surgery, the trauma of ALPPS surgery has a further reduction, and the morbidity and mortality have gradually been decreased. It is believed that with the continuous advancement and improvement of ALPPS surgery technology, the indications and safety of ALPPS will be further enhanced, bringing hope to more patients with intermediate to advanced liver cancer with huge tumors.
In order to observe the effect of hepatocyte growth promoting factor (pHGF) on liver regeneration of rat with cirrhosis after hepatectomy, IBAS Ⅱ auto image analysis technology was used to measure the variety of DNA ploid rate of hepatocytes and OPTDM of enzymes by liver histochemistry after hepatectomy; serum levels of the glutamicpyruvic transaminase (SGPT) and indocyanine green retention rate in 15 minute (ICG15) were tested to measure the function of the remanent liver. The results revealed that tetraploid hepatocytes lowered greatly and diploid, quintploid and ＞quintploid hepatocytes increased apparently in group A. OPTDM of enzymes by liver histochemistry showed no significant difference at the first day after operation in each group (Ｐ＞0.05); SDH and LDH of group A were significantly higher than those of group B and AkP, AcP were significantly lower at the second or fifth day after hepatectomy. Serum tests showed that SGPT, ICG15 of group A decreased apparently at the fifth day after operation. The results demonstrate that pHGF not only stimulates the regeneration of the remanent liver but also accelerates the functional mature of the regenerative hepatocytes and the functional recovery of the remanent liver after resection of cirrhotic liver of rats.
【Abstract】 Objective To study liver regeneration of the non-ligated liver lobes following portal branch ligation (PBL). Methods Sixty male Wistar rats were randomly divided into PBL group and sham operation (SO) group. Under ether anesthesia, the rats were subjected to PBL and sham operation, respectively. The animals were sacrificed on the 1st, 2nd, 3rd, 7th and 14th day respectively. The blood sample was collected from heart and the livers were harvested to determine serum alanine aminotransferase (ALT) levels and total liver weight, respectively. The hepatic histopathology was studied through light microscopy. The number of liver cell nuclear mitosis index was counted. The number of proliferative cell nuclear antigen (PCNA) index was counted by immunohistochemistry. The hepatic ultrastructural changes were studied under electron microscope. Results ①Elevated serum ALT level was observed in the first postoperative day in PBL group compared with SO group (P＜0.01)， but began to recover in the second day. ②No significant total liver weight change in PBL group and SO group were found. ③Liver cell nuclear mitosis index and PCNA index were markedly increased in PBL group compared with SO group in day 1-3 postoperative day (P＜0.01). It reached the peak in the second day and decreased slightly in the 3rd day, but still higher than SO group, then gradually return to normal lately. Conclusion The ligation of left portal branch can induce active regeneration of hepatic cell of non-ligated liver lobes in rats. The regeneration of non-ligated liver lobes may restore previous total liver weight. The ligation of 75% portal branch does not affect liver function and may be safely performed. The portal branch ligation in rats may be used as an animal model in study of liver regeneration.
Objective To summarize the research progress on the regulation of hepatic sinusoidal microenvironment to promote liver regeneration based on liver sinusoidal endothelial cells (LSECs), aiming to further clarify the mechanism of liver regeneration and provide new ideas and methods for clinical promotion of liver regeneration and prevention of liver failure. Method The basic and clinical research studies on LSECs and liver regeneration at home and abroad in recent years were searched and reviewed. Results Differentiated LSECs played an important role in liver regeneration, regulated the homeostasis of hepatic sinusoid microenvironment by paracrine and autocrine, and participated in the whole process of promoting liver regeneration, such as hepatocyte proliferation and neovascularization after acute and chronic liver injury. Conclusion In the process of liver regeneration after all kinds of acute and chronic liver injury, LSECs promote liver regeneration by regulating hepatic sinusoid microenvironment, which will provide new strategies and methods for clinical promotion of liver regeneration and prevention of liver failure after hepatectomy.
OBJECTIVE: To validate the hemostatic properties of collagen sponge made in China. METHODS: The experimental model of superficial cut of liver was established in 20 Sprague-Dawley adult rats, which were divided into two groups randomly. Collagen sponge or gelatin sponge was used to cover the cut respectively. Hemostatic result was observed. Afterwards, standard liver trauma model by resection left front liver lobe was made, wound was treated with collagen sponge or gelatin sponge respectively. Hemostatic result was observed. Concurrent hemostatic time and bleeding amount were noted. At 7, 14 and 20 days after operation, intra-abdominal adhension, infection and healing state of liver were observed by exploratory laparotomy. The histological changes of regenerate liver tissue were observed by microscopy. RESULTS: Collagen sponge adhered to wound well. Concurrent hemostatic time and bleeding amount in collagen sponge group were superior to those of gelatin sponge (P lt; 0.05). The histological examination showed that collagen sponge was absorbed and degraded rapidly, regenerative hepatocytes could be induced. CONCLUSION: Collagen sponge has fine hemostatic properties and can induce regeneration of hepatocytes effectively. It is worth popularizing for its convenience in clinical application and its properties of rapid degradation and absorption.
ObjectiveTo investigate the role of endoplasmic reticulum stress in liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).MethodsSeventy-two C57bl/6 mice were randomly divided into ALPPS group, portal vein ligation group (PVL group), and sham operation group (Sham group), 24 mice in each group. And then one-stage ALPPS operation, simple PVL, and sham operation will be performed. Six mice were randomized selected of the three groups on the 1st, 2nd, 4th, and 7th day after surgery, respectively, the liver weight to body weight ratio (FLR/BW) of each group was measured, and the liver tissues were taken for immunohistochemical staining to calculate the proportion of Ki-67 positive cells, Western blot was used to detect the expression levels of X-box binding protein 1 (XBP1) and inositol-requiring enzyme 1α (IRE1α) proteins.Results① FLR/BW: On the 4th day and the 7th day after operation, the FLR/BW of the Sham group, PVL group, and ALPPS group increased in sequence at the same time, and the difference between the three groups was statistically significant (P<0.05). ② Ki-67 positive cell ratio: On the 2nd day after operation, the ratio of Ki-67 positive cells in the Sham group, PVL group, and ALPPS group increased sequentially, and the difference between the two groups was statistically significant (P<0.05). On the 4th day after operation, the ratio of Ki-67 positive cells in the PVL group and the ALPPS group were still higher than that of the Sham group (P<0.05). ③ Expression levels of XBP1 and IRE1α: On the 2nd and 4th postoperative day, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group and the PVL group (P<0.05). On the 7th day after surgery, the expression levels of XBP1 and IRE1α in the ALPPS group were higher than those in the Sham group (P<0.05), while compared with the PVL group, the expression level of XBP1 in the ALPPS group was still higher (P<0.05).ConclusionsALPPS-induced liver regeneration is more advantageous than traditional PVL in mice. It may be attributed to the obvious endoplasmic reticulum stress activation after ALPPS leading to the up-regulation of IRE1α-XBP1 expression, which is involved in the regulation of hepatocyte cell cycle and promotes hepatocyte proliferation, thus promoting rapid liver regeneration.
ObjectiveTo investigate the protective effect of SadenosylLmethionine on liver regeneration and liver function in cirrhotic rats after hepatectomy. MethodsCirrhosis was successfully induced by injection of 40% CCl4.Then,partial hepatectomy (about 30%) was performed in all rats. Cirrhotic rats were divided into 3 groups,namely,cirrhotic group (normal saline 5 ml/d,for 15 postoperative days，n=20),treatment group 1 〔S adenosylLmethionine 10 mg/(kg·d),for 15 postoperative days,n=16〕 and treatment group 2 〔SadenosylL methionine 20 mg/(kg·d),15 postoperative days,n=16〕,and normal control group was also established. Animals were sacrificed at the 15th postoperative day and 30th postoperative day to take samples for detection of liver function (Alb,ALT,TB,TBA) and serum TNFα.Liver tissues were also observed under light microscope and electron microscope. ResultsIn two treatment groups,at the time point (15 postoperative days or 30 postoperative days),concentrations of ALT,TB,TBA,Alb and TNFα were decreased significantly as compared with cirrhotic group (P ＜0.01),and concentration of Alb was increased significantly (P＜0.01).In contrast, there were no obvious difference in the same time point of different dosetreatment groups (Pgt;0.05),but the decrease of ALT,TB,TBA,TNFα and the increase of Alb were more significant at the second time point (30th postoperative day) than the first time point (15th postoperative day) when treated with same dose (P＜0.01).At the same time,concentration between TNF α and ALT,TB,TBA showed a positive correlation (P＜0.01),and the concentration between TNFα and Alb showed a negative correlation (P＜0.01).In addition, the histopathology showed SadenosylLmethionine had effects of protecting liver function and enhancing liver regeneration. ConclusionThe study suggests that SadenosylL methionine has the efficacy of enhancing liver regeneration and improving liver function.
Objetive To summarize the mechanism and the application of the research on liver regeneration. Methods The related literatures about enteral liver regeneration in recent years were reviewed. Results Even though liver regeneration after liver resection has been widely studied, we can get better understanding from new clinical application. The process of regeneration induced liver injury rarely occurs in the normal liver. Many studies have focused on the mechanism of liver cell regeneration after liver injury. For example, the study of liver regeneration related factors and liver regenerative cells, but the specific mechanism is still not very clear. Recent techniques using the obvious progress in understanding liver regeneration are portal vein embolization and the associating liver partition and portal vein ligation for staged hepatectomy. Living donor liver transplantation is one of the most significant clinical outcomes of research on liver regeneration. Another involved in liver regeneration is the main field of stem cell therapy. Conclusion Great understanding liver regeneration should provide to the development of new treatment strategies and diagnostic procedures for various liver diseases.
Objective To analyze and summarize the research progression of phenotypic markers of hepatic sinusoidal endothelial cell （HSEC） and its role in the development and progression of the liver diseases. Methods Databases such as PubMed， Wanfang， CNKI， etc were retrieved for the latest articles on research advance in HSEC using “hepatic sinus endothelial cell”， “liver regeneration”， and “liver disease” as key words. All of the publications about studies on relation between HSEC and liver disease were reviewed and summarized. Results HSEC with specific cytoarchitectures and phenotypic markers was initially received “the message of damage” in the process of liver regeneration， hepatic immunological tolerance， hepatic fibrosis， and liver damage. Additionally， HSEC as the first barrier not only enabled liver to be protected but also was regarded as the first alternation of liver damage. Therefore， HSEC played a great important role in the process of the onset and progression of the liver disease. Conclusions The function of HSEC is complex. How do play a role and its the mechanism is unclarified， it is needed to be further studied.