AIM: To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.METHODS: A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occl...AIM: To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.METHODS: A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occlusion was performed.The mesenteric venous inflow was diverted through a mesocaval shunt(MCS) constructed using the prepared left renal vein with an end-to-side running suture of 5-0 proline.All 21 animals that underwent subtotal hepatectomy and/or MCS were divided into three groups.In the 15% group,the residual volume was 14%-19% of total liver volume(TLV);in the 15%+ S group,the residual volume was also 14%-19% of TLV with a mesocaval shunt(MCS);and in the 10%+ S group,the residual volume was 8%-13% of TLV with an MCS.In the three groups,the intraoperative portal vein pressure(PVP) and portal vein flow(PVF) were monitored and compared at laparotomy and 1 h posthepatectomy.The survival rate,sinusoidal endothelial damage,tissue analysis,and serum analysis were investigated among the three groups.RESULTS: The percentage residual liver volume was 15.9%,16.1% and 11.8% in the 15%,15%+ S,10%+ S groups,respectively.After hepatectomy,PVF and portal-to-arterial flow ratio in the 15%+ S group significantly decreased and hepatic artery flow(HAF) per unit volume significantly increased,compared to those in the 15% group.The PVP in the 15%+ S group and 10%+ S group increased slightly from that measured at laparotomy;however,in the 15% group,the PVP increased immediately and significantly above that observed in the other two groups.The 14-d survival rates were 28.5%,85.6%,and 14.2% in the 15%,15%+ S,and 10%+ S groups,respectively.In the 15%+ S group,the shunts effectively attenuated injury to the sinusoidal endothelium,and the changes in the serum and tissue analysis results were significantly reduced compared to those in the 15% and 10%+ S groups.CONCLUSION: MCS can decompress the portal vein and so attenuate liver injury from hyperperfusion,and make extreme or marginal hepatectomy safer.展开更多
The present study was aimed at dynamic observation of the ef fects of end to side portacaval shunt (PCS) and end to side mesocaval shunt (MCS) in dogs on the functions of the liver and pancreatic islet cells. Accordin...The present study was aimed at dynamic observation of the ef fects of end to side portacaval shunt (PCS) and end to side mesocaval shunt (MCS) in dogs on the functions of the liver and pancreatic islet cells. According to correlation between the changes of plasma insulin level in the portal vein and hepatic flow and liver morphology after PCS and MCS, we conclude that the depletion of hepatic flow is the major factor in the deterioration of liver functions. The levels of insulin and glucagon in both the peripheral vein and the portal vein were decreased after PCS and MCS. There was also depletion of pancreatic islet A and B cells and vacuolar degeneration of the pancreas. These changes were more signifcant in PCS than in MCS, suggesting that portasystemic shunt, especially total portasystemie shunt, might damage pancreatic endocrine functions.展开更多
文摘AIM: To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.METHODS: A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occlusion was performed.The mesenteric venous inflow was diverted through a mesocaval shunt(MCS) constructed using the prepared left renal vein with an end-to-side running suture of 5-0 proline.All 21 animals that underwent subtotal hepatectomy and/or MCS were divided into three groups.In the 15% group,the residual volume was 14%-19% of total liver volume(TLV);in the 15%+ S group,the residual volume was also 14%-19% of TLV with a mesocaval shunt(MCS);and in the 10%+ S group,the residual volume was 8%-13% of TLV with an MCS.In the three groups,the intraoperative portal vein pressure(PVP) and portal vein flow(PVF) were monitored and compared at laparotomy and 1 h posthepatectomy.The survival rate,sinusoidal endothelial damage,tissue analysis,and serum analysis were investigated among the three groups.RESULTS: The percentage residual liver volume was 15.9%,16.1% and 11.8% in the 15%,15%+ S,10%+ S groups,respectively.After hepatectomy,PVF and portal-to-arterial flow ratio in the 15%+ S group significantly decreased and hepatic artery flow(HAF) per unit volume significantly increased,compared to those in the 15% group.The PVP in the 15%+ S group and 10%+ S group increased slightly from that measured at laparotomy;however,in the 15% group,the PVP increased immediately and significantly above that observed in the other two groups.The 14-d survival rates were 28.5%,85.6%,and 14.2% in the 15%,15%+ S,and 10%+ S groups,respectively.In the 15%+ S group,the shunts effectively attenuated injury to the sinusoidal endothelium,and the changes in the serum and tissue analysis results were significantly reduced compared to those in the 15% and 10%+ S groups.CONCLUSION: MCS can decompress the portal vein and so attenuate liver injury from hyperperfusion,and make extreme or marginal hepatectomy safer.
基金Supported by Chinese Ministry of Health,China,No.200802012the Project of National Natural Science Foundation of China,No.81271738the National Science and Technology Major Project,No.2012BAI06B01
文摘AIM: To investigate the impact of portal inflow on liver remnants in a stable pig model of small-for-size syndrome.
基金This project was supported by the Science Fund of be Chinese Academy of Sciences
文摘The present study was aimed at dynamic observation of the ef fects of end to side portacaval shunt (PCS) and end to side mesocaval shunt (MCS) in dogs on the functions of the liver and pancreatic islet cells. According to correlation between the changes of plasma insulin level in the portal vein and hepatic flow and liver morphology after PCS and MCS, we conclude that the depletion of hepatic flow is the major factor in the deterioration of liver functions. The levels of insulin and glucagon in both the peripheral vein and the portal vein were decreased after PCS and MCS. There was also depletion of pancreatic islet A and B cells and vacuolar degeneration of the pancreas. These changes were more signifcant in PCS than in MCS, suggesting that portasystemic shunt, especially total portasystemie shunt, might damage pancreatic endocrine functions.
