ABSTRACT
The proliferative capacity of non-ligated liver lobes was designned experimental study on dogs in which portal vein and hepatic artery ligation was done either simultaneously or heterochronously. Dogs were divided into four groups: G I [control G]; laparotomy was performed without vascular ligation, G II; dogs were subjected to ligation of the right lateral and median branches of portal vein alone, G III, dogs were subjected to hepatic artery branches ligation 48h after portal vein branches ligation. G IV, dogs were subjected to ligation of the same branches of the portal vein and hepatic artery simultaneously. Dogs from each group were subjected to a liver biopsy before and 24, 48, 72, and 168h [one week] after surgery. Standard serum liver functions were tested before ligation, 72 hs and one week after ligation. Hepatic regeneration in the non-ligated lobe was assessed through histopathological study, DNA quantitation of the hepatic nuclei by the computerized image analysis system and estimation of proliferation marker in hepatic tissue. In this study, the labeling index of the nuclear factor NF Kappa B [PI05], a novel monoclonal antibody specific for PI05 protein, was determined immunohistochemically. Results showed induction of the NK kappa B [P105] labeling index showed maximum levels G III. Quantitative determination of serum glutamicoxaloacetate transaminase [GOT] showed peak levels in G IV at 24h after surgery. Our finding for this index that heterochronous partial portal vein and hepatic artery ligation [i.e., G III] is effecttive, because this procedure leads to an increase in the compensatory hypertrophy of the nonligated liver lobes that depends on the regenerative capacity of the lobes themselves. In contrast, in G IV [i.e., synchronous ligation of portal vein and hepatic artery branches] liver regeneration did not occur due to the severe systemic damage induced by infectious necrosis in the ligated lobe. The serial changes in liver function in G III indicate that the use of this technique may minimize dysfunction in the remaining hypertrophied liver lobes, similar to findings in G II. So, the PVBL plus heterochronous HABL procedure is safer and more effective than PVBL alone, or PVBL plus simultaneous HABL. A better knowledge of the events following such heterochronous ligation should improve the clinical outcome of hepatic resection for liver diseases
Subject(s)
Male , Animals , Portal Vein , Hepatic Artery , Ligation/adverse effects , Liver Regeneration , Dogs , HistologyABSTRACT
The present study was conducted on 170 patients with intractable ascites secondary to liver cirrhosis. The present study showed that both peritoneo-venous and lympho-venous shunts are technically simple procedures that could be done under local anesthesia in nearly similar time duration. However, Denver shunt is expensive, it costs between LE 4000-6000. Lympho-venous shunt is a biological cheap procedure. It can be concluded from this study that patients with intractable ascites could be offered surgical therapy with either shunts with a high success rate. Cervical lympho-venous shunt appears to be a simple, safe, cheap and effective method for achieving a long-term control of refractory ascites. The use of a biological shunt is an added advantage over prosthetic shunts for drainage of ascetic fluid with almost negligible complications. Failure does not interfere with the future use of the expensive peritoneo-venous Denver shunt. Denver peritoneo-venous shunt is a good device to relieve ascites, thereby reducing the risk of complications and the number of hospital admissions due to repeated paracentesis and consequently improving the quality of life. However, its high cost limits its wide scale application. A careful patient selection is mandatory for optimal results