Experimental Study Of The Effect Of Internal And External Biliary Drainage On Liver Regeneration Of The Obstructive Jaundice Rats Following Partial Hepatectomy

Objective:The strategy for radical surgery therapy of hilar cholangiocarcinoma is combined with extended hepatectomy. However, most of patients with hilar cholangiocarcinoma are complicated with different levels of obstruction jaundice. The damage induced by obstruction jaundice could lead to liver failure which is the deadly partial hepatectomy (PH) complication. Previous study has found that preoperative biliary drainage could decrease the risk of liver failure and improve total body conditions to tolerate the operation. It is controversial which method of biliary drainage is better to improve total body conditions. So we try to establish the model of obstruction jaundice SD rats drainaged internal and external following PH, and to evaluate the effect of internal and external biliary drainage on liver regeneration of the Obstructive Jaundice Rats following PH and to provide a theoretical basis for clinical application.Methods:The SD rats model of obstructive jaundice was established by common bile duct ligation and division. After7days, internal and external biliary drainage were builded in different groups by another operation. The obstructive jaundice SD rats were received left and middle lobe hepatectomy(about70%of total liver), and also the SD rats drainaged for7days were performed the operation. At Oh,1h,2h,4h,12h,24h,48h and72h after PH, the rats were succumbed and the specimens of blood and liver were collected. The levels of TBIL, ALB, ALT, AST in serum were determined, the levels of TNF-a and IL-6in serum were measured by ELISA and the expression of PCNA, STAT3in residual liver tissue were analyzed by immunohistological technology.Results:(1) The mortality rates of rats following PH in ID group were significantly lower than in OJ group and ED group.(2) The levels of TBIL, ALT and AST in ID group and ED group were significantly lower than in OJ group at every moment.(3) The levels of ALB in ID group were significantly higher than in OJ group and ED group at every moment.(4) After PH, the liver regeneration rates in ID group were significantly higher than in OJ group and ED group at72h.(5) After PH, the expression of MI and PCNA in all of groups were obviously increased at12h, and peaked at24h in ID group.The expression of MI and PCNA peaked at48h in OJ group and ED group, and the peak values were delayed and significantly lower than the ID group.(6) After PH, the expression of STAT3peaked at4h in ID group and at12h in OJ group and ED group.(7) After PH, the levels of TNF-a and IL-6in serum were obviously elevated in all of groups. The levels peaked at12h in ID group and at24h in OJ group and ED group. The levels of TNF-a and IL-6in ID group were significantly lower than in OJ group and ED group at every moment.Conclusions:1In our study, we established the animal model successfully for simulation the pathological and psychical features of hilar cholangiocarcinoma with preoperative internal and external biliary drainage following extended hepatectomy. The operation is replicative and stabile.2Both internal and external drainage can improve liver regeneration of obstructive jaundice rats following PH, but the liver regeneration after internal drainage is better improved.3The potential mechanism to improving liver regeneration of obstructive jaundice rats following PH is that internal biliary drainage can decreased the levels of TNF-α and IL-6, and influence the expression of STAT3.