The Best Timing For Associating Liver Partition And Portal Vein Ligation For Staged Hepatectomy In Rats

OBJECTIVE:Objective:1.To compare the large-scale postoperative hepatectomy of ALPPS(Asscoiating liver partition and portal vein ligation for staged hepatectomy)with the sham operation group at different time.Rat survival rates are different,is the difference statistically significant?2.Collect the survival rate of SD rats after two-stage liver resection at different time points after combined liver dissection and portal vein ligation.Establish a trend chart of the relationship between the remaining liver regeneration rate and the survival rate after secondary liver resection,the time point of secondary liver resection,and the changes in liver function.Methods:95 male SD rats with a mass of 230 ±20 were selected.Five rats were randomly selected for liver anatomy and the average liver mass of SD rats was measured.The remaining rats were randomly divided into groups:control group(n=30)The portal vein branches of the right lateral lobe,left middle lobe,and left lateral lobe were separated posteriorly,and the caudate lobe was excised.In the ALPPS group(n=60),the portal vein branches of the right lateral lobe,left middle lobe,and left lateral lobe were separated and ligated after laparotomy,and the caudate lobe was excised,and the liver parenchyma of the left and right middle lobe was separated by 80%.The random number table in the control group was divided into 5 groups,S1,S2,S3,S4,and S5 n=6,and each group took blood at different time points at 1,3,7,10,and 14 days after primary surgery to measure rat serum ALT.(Alanine amiontrasferses,aspartame transaminase)and AST(Aspartame transaminase,aspartame transaminase)concentrations were performed in two-stage liver resection.Group ALPPS random number table is divided into 5 groups,Al,A2,A3,A4,A5 n=12,each group is randomly divided into surgery group and liver test group n=6,surgery group after a period of Blood samples were taken at different time points on 1,3,7,10,and 14 days to measure the serum ALT and AST concentrations in rats,and two-stage liver resection was performed.The rats in each group were sacrificed and the residual HRR(Hepatic regeneration rate)was measured.Data collection:Blood samples were taken to detect the serum ALT and AST concentrations of rats in each group at different time points of 1,3,7,10,and 14 days before liver resection,and the rats and controls in the ALPPS group were recorded after two-stage liver resection.One-week survival rate of the rats in the group.Results:The ALT(U/L)concentrations of rats in each group of ALPPS were 768.9 ± 106.2,245.1 ± 25.8,60.2 ± 12.4,50.9 ± 10.2.,42.3 ±11.2,and AST(U/L)concentration of 1230.3 ± 227.1,381.3 ± 45.5,261.3 ± 25.0,159.8 ± 24.7,107.5 ± 7.2.The ALT(U/L)concentration of the rats in the control group was 32.5 ± 9.12,35.3 ± 8.85,34.0 ± 6.01,32.0 ± 6.14,30.4 ± 4.05,and AST(U/L)concentration of 105.8 ± 11.6,102.1 ±11.2,103.6 ± 12.5,100.2 ± 11.5.The data were analyzed by SPSS 19.0 statistical software,and the two groups of data were analyzed by t test.The ALT and AST concentrations in the group of ALPPS were significantly higher than those in the control group(P<0.05),and the difference was statistically significant;The survival rates of rats in each group of ALPPS after secondary liver resection(%)were 0,33,67,83,and 83,respectively.The survival rates of rats in the control group after the second-stage liver resection(%)were 0,0,17,33,and 33,respectively.Compared with the control group,the survival rate of the ALPPS group was significantly higher than that of the control group after the second-stage liver resection.The survival time of the rats was analyzed using the SPSS 19.0 statistical software to draw the Kaplan-Meier survival curve.The survival rate of the rats in the control group and the group ALPPS within one week after operation was compared by Log Rank test.P<0.05 was considered statistically significant.The results were S1 to A1;S2 to A2.P>0.05 considered that the survival rate was not different.The difference was that A3 was better than S3;A4 was better than S4;A5 was better than S5.The relationship between ALT,AST concentration changes,liver regeneration rate,and postoperative survival rate in the ALPPS group at different time points after the first-stage operation was plotted into a trend chart From the relationship trend chart,it was considered that it was about one week after the first-stage operation.Changes in rat liver regeneration rate,liver function,and liver resection survival rate were stable.Conclusion:This experiment successfully established a two-step hepatectomy rat model of ALPPS,and observed changes in liver regeneration rate,liver function,and survival rate of the rats around one week after the first period of operation.And the Log rank test analysis shows that the rat's survival rate is different after the first-stage two-stage liver resection after 7 days of primary surgery,so rat ALPPS surgery should be performed not less than 7 days after the first-stage surgery.Two-stage liver resection is a relatively good time in theory.It can also be used clinically to learn from this experimental idea,collect past data,and estimate the best time for patients who need this procedure for second-stage liver resection as a reference with good surgical results.