| [Objective] To explore the liver regenerative characteristics of LDLT donor when congestion occurs, improve the understanding of the impact of congestion on the HCC remnant liver regenerative after operation, establish rat model of subtotal liver lobe resection with selective liver lobe congestion, and investigate the regeneration characteristics of congestive liver and the related mechanism.[Method] Clinical trials:LDLT donor was divided into two groups:with and without hepatic vein. Each group consisted of30patients. IQQA-MSCT was used as the method of preoperative donor evaluation. Volume of segment Ⅳ, Ⅱ, Ⅲ, and the total remnant liver before and two weeks after surgery were recorded and compared. The hepatic regeneration patterns of different segments of congestive liver were investigated. Animal experiments:Establish rat model of subtotal liver lobe resection with selective liver lobe congestion; experimental animals were divided into control group and liver resection in combination of caudate lobe congestion group. Survival rate of rats, liver regeneration of various lobes at specified time and in different groups, liver function, liver pathology, TNF--α levels, and hepatocyte growth-promotting factors and other indicators were studied to examine the regeneration pattern of congestive liver and the possible signaling mechanism.[Results]1. Preoperative liver volume assessment with IQQA-MSCT in LDLT was positively correlated with the actual liver weight (p<0.001). Hepatic vein, portal vein, hepatic artery three-dimensional reconstructions were conducted and classified, results were confirmed by surgery.2. The left lateral regeneration rate was higher in no congestion group compared with congestion group (p<0.05). The overall regeneration of remnant liver was not significantly different (p>0.05).3. A group and C group both developed liver congestion in corresponding lobe. For B group, complete congestion on the upper caudate lobe accounted for60%of the group, lower part caudate lobe accounted for80%of the group after ligated the caudate lobe vein seperately.4. With the proportion increase of liver resection, early postoperative liver regeneration gradually strengthened. HGF, TNF-a, and the mitotic G1phase and S phase cells increased significantly as well. For POD5, no significant difference was found among the three groups, and ultimately all rats achieved a normal liver weight. 5. Compared with B group, A group had a significantly higher level of HGF, TNF-α, PCNA, S phase cells in the POD1,2and3. For POD5, no significant difference was found in these factors. The overall liver regeneration rates were also not significantly different. Compared with C group, A group had a significantly higher level of HGF, TNF-a, PCNA, S phase cells in POD1and POD2. In terms of POD3and POD5between C group and A group, the difference was not significant. Overall regenerate ratio was similar.[Conclusion]1. Congestion does not affect overall liver regeneration. Overall regeneration of remnant liver is closely related to the volume of residual functional liver. In the circumstances of compensation, regeneration rate is higher. IQQA-MSCT is an effective method for LDLT donor eveluation.2. Because of the unstable outcome of separately caudate lobe vein ligation, Model with caudate lobe congestion should choose ligation caudate lobe hepatic vein after dissecting the portal area. For the simple, reliable and high survival rate, it is an ideal model for basic research on liver regeneration about the effect of congestion.3. Within the extent of safe resection, the more the liver is removed, the more and faster the liver is regenerated. TNF-a and HGF are important stimuli of liver regeneration in the initial stage and replication regeneration stage.4. Congestion area is not fully necrosis is confirmed by pathology. It has certain function especially in the early postoperative period. The congestion area helps to maintain the patient’s physiological functions and provide the opportunity of accelerated regeneration of the no congestion areas, especially for those with smaller remnant liver or graft. Acute phase response in congestion areas induces the increase of hepatocyte growth-promoting factors, promotes the early regeneration of non-congestion areas, and does not affect overall liver regeneration. |
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