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首页> 外文期刊>Annals of Surgery >Comparative study of portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant using a mini-pig model.
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Comparative study of portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant using a mini-pig model.

机译：使用小型猪模型对门静脉栓塞术与门静脉结扎术诱导未来肝残余肥大的比较研究。

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SUMMARY BACKGROUND DATA: The extent of hepatectomies is limited by the functional reserve of the remnant liver. The introduction of preoperative portal vein occlusion techniques to induce a preoperative hyperplasia of the future liver remnant has reduced the risk of postoperative liver failure. However, it has remained a matter of debate whether partial portal vein embolization (PVE) or suture ligation of the portal branches during exploration is the preferred technique. We compared both techniques under standardized experimental conditions in a large animal model by means of effectiveness and pathophysiologic differences. METHODS: Thirteen mini-pigs underwent portal vein ligation (PVL), 11 mini-pigs underwent PVE of 75% of the liver volume, and 6 underwent a sham operation. The animals were killed after 28 days. Laboratory liver function and damage parameters, lobar liver-to-body weight indices, portal and arterial flow alterations, and histologic changes were assessed. Ex situ arteriograms and portograms were performed to examine adaptive changes in the macroarchitecture of both vascular systems. RESULTS: The liver-to-body weight index of the nonoccluded lobe was highest after PVE (0.85) versus 0.6 (P < 0.05) after PVL. There was no significant reduction in global serum parameters reflecting total liver function. After 4 weeks, the PVL group consistently exhibited hepatopetal portal flow in the ligated lobes, which was present but significantly decreased after PVE. The ex situ angiography after PVE and PVL revealed the development of portal neocollaterals in the portal-occluded liver parts. CONCLUSIONS: Both PVL and PVE are able to induce hypertrophy of the future liver remnant. In comparison, PVE is the more effective technique to increase the future liver remnant. This is due to a more effective, durable occlusion of the portal branches. Formation of collaterals between occluded and nonoccluded liver parts seems to be the cause of inferior regeneration in the ligation group.
机译：摘要背景数据：肝切除的范围受到残余肝脏功能储备的限制。术前门静脉闭塞技术的引入可引起术前未来肝残余的增生，降低了术后肝衰竭的风险。然而，在探索过程中是否部分门静脉栓塞（PVE）或门静脉分支的缝合结扎是否是首选技术仍是一个争论的问题。我们通过有效性和病理生理学差异，在大型动物模型中的标准化实验条件下比较了这两种技术。方法：13只小型猪接受了门静脉结扎（PVL），11只小型猪接受了占肝脏体积75％的PVE，6例进行了假手术。 28天后将动物处死。评估实验室的肝功能和损伤参数，大叶肝体重指数，门脉和动脉血流改变以及组织学变化。进行了异位动脉造影和门静脉造影，以检查两个血管系统宏观结构的适应性变化。结果：PVE后未闭塞肝叶的肝脏重量指数最高（0.85），而PVL后最高（0.6

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