Experimental Study On Regenerative Ability Of The Remnant Hepatic Lobe After Liver Resection With Major Hepatic Vein Occlusion In Rats

Objective To explore the regenerative ability of the remnant hepatic lobe after liver resection combining with major hepatic vein(MHV) occlusion through acute or chronic occlusion model of MHV in rats.Methods ninty six rats were randomly divided into control group,the group of liver resection with left MHV stricture,the group of liver resection with left MHV ligation and the group of liver resection with left segmental hepatic vein ligation.The pressure and hemodynamic changes of portal vein,the level of TXB2-6-keto-PGF1a and endotoxin in portal vein blood,the weight of liver,mitotic indices of hepatocytes and DNA synthesis rate of hepatocytes were dynamically determined to explore the regenerative ability of the remnant hepatic lobe after liver resection with MHV occlusion,Results The level of endotoxin,TXB2 in portal vein blood increased and regenerative ability of hepatocytes obviously deacrease in the group liver resection with left MHV stricture,the group of liver resection with left MHV ligation.The pressure of portal vein increase and the inflow of portal vein blood decrease.Much the MHV occlusive extent is,higher the level of endotoxin and the TXB2 are and lower the regenerative ability of hepatocytes after liver resection with MHV occlusion is.Therefore we consider that the causes of low regenerative ability of hepatocytes are as follows,endotoxemia in portal vein blood resulted in edema and denaturalization of hepatocytes.low blood inflow of portal vein resulted in decreasing of hepatotrophic factors.Disorder of hepatic microcirculation resulted from high level of TXB2 in portal vein blood and liver congestion induce lack of blood and deoxygen of hepatic parenchyma.Conclusion Acute or chronic occlusion of MHV could impact severely regeneiative ability of hepatocytes.Acute occlusion of MHV including one or more than one MHVs must be avoided for the patients with hepatic cirrhosis background during the process of liver resection.The patients with large liver cancer nearby the inferior vena cava or involved MHV must be performed on liver resection with MHV and hepatic vein reconstruction for preserving remnant liver parenchyma.The drugs of improving hepatic microcirculation were routinely administrated to accelerate regenerative ability of hepatocytes after liver resection with MHV occlusion.When performing VII and VIII segmentectomy with right hepatic vein and preserving V and VI segments at the same time.the patients must be proved to have right inferior hepatic vein in the liver through B mode ultrasound and other imaging examinations before operation and during operative process.