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目的:建立联合肝脏分割和门静脉结扎(PVL)二步肝切除术(ALPPS)大鼠模型。方法:将健康60只SD雄性大鼠随机均分为PVL组、ALPPS组、假手术组。PVL组行肝左外叶、左中叶、右叶门静脉分支结扎及尾状叶切除,保留肝右中叶分支;ALPPS组在PVL组手术的基础上,将肝左中叶与右中叶在缺血带处离断;假手术组仅游离出门静脉各分支,不结扎。检测大鼠术后肝再生率(HRR)、肝功能情况,以及肝左中叶病理损伤程度与肝右中叶Ki-67的表达。结果:与假手术组比较,ALPPS组、PVL组术后各时间点肝右中叶HRR均明显升高(均P<0.05),且第4、7天ALPPS组肝右中叶HRR明显高于PVL组(155.96%vs.118.15%;174.86%vs.133.55%,均P<0.05)。PVL组术后早期肝功能指标好于ALPPS组(均P<0.05),但后期无统计学差异(均P>0.05)。组织病理学检查显示,ALPPS组术后第1天肝左中叶坏死明显多于PVL组;ALPPS组肝右中叶Ki-67表达第2、4天明显高于PVL组(85.36%vs.61.84%;43.40%vs.29.06%,均P<0.05)。结论:ALPPS与PVL均能促进肝再生,并且ALPPS比PVL能更快的促进肝再生;成功建立大鼠ALPPS模型,为研究ALPPS肝再生机制及相关并发症奠定了基础。
Objective: To establish a rat model of liver segmental and portal vein ligation (PVL) two-stage hepatectomy (ALPPS). Methods: Sixty healthy SD male rats were randomly divided into PVL group, ALPPS group and sham operation group. PVL group left hepatic lobe, left middle lobe, right lobe portal vein ligation and caudate lobe resection, retaining the right middle lobe branch; ALPPS group PVL group surgery, the left middle lobe of the liver and right middle lobe in the ischemic zone Off; sham-operated group only free from the branches of the portal vein, not ligation. The postoperative liver regeneration rate (HRR), liver function, and the degree of pathological damage in the left middle lobe and the expression of Ki-67 in the right middle lobe were detected. Results: Compared with the sham operation group, the HRR of the right middle lobe of ALPPS group and PVL group were significantly increased at all time points (all P <0.05), and HRR of the right middle right ALPPS group was significantly higher than that of the PVL group (155.96% vs.118.15%; 174.86% vs.133.55%, all P <0.05). The indexes of early liver function in PVL group were better than those in ALPPS group (all P <0.05), but there was no significant difference in late stage (all P> 0.05). Histopathological examination showed that ALPPS group had significantly more left middle lobe necrosis than PVL group on the first postoperative day. Ki-67 expression in the right middle lobe of ALPPS group was significantly higher than that of PVL group on the first and second days (85.36% vs.61.84% 43.40% vs.29.06%, all P <0.05). CONCLUSION: Both ALPPS and PVL can promote liver regeneration, and ALPPS can promote liver regeneration more quickly than PVL. Successful establishment of rat ALPPS model lays a foundation for studying the mechanism of ALPPS and related complications.