ABSTRACT
Objective To observe the effects of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) on liver regeneration of the unligated lobe with cirrhosis.Methods 60 liver cirrhosis SD rats were randomly divided into three groups:C-ALPPS group (n =20,liver cirrhosis + ALPPS),C-PVL group (n =20,liver cirrhosis + PVL) and C-Sham group (n =20,liver cirrhosis + sham operation).60 normal SD rats were randomly divided into three groups:N-ALPPS group (n =20,normal liver + PVL),N-PVL group (n =20,normal liver + PVL) and N-Sham group (n =20,normal liver + sham operation).The weight ratio of unligated lobes/total liver,proliferating cell nuclear antigen (Ki-67) and liver function were compared before operation and 2,4 and 7 days after operation.Results Except for sham operation group,liver weight ratios of unligated livers on the 4th and 7th days after operation were lower than those in the normal group (P ＜ 0.05).The weight ratios of unligated lobes/total liver in C-ALPSS group and N-ALPPS group on 4th and 7th day postoperation were (54.3 ± 3.1)％ vs.(61.2 ± 2.1)％,(65.0 ± 4.1) ％ vs.(79.2 ± 1.1) ％.The weight ratio unligated lobes/total liver in group C-PVL and group N-PVL at 4th and 7th day postoperation were (52.4 ± 1.8) ％ vs.(56.6 ± 2.0) ％,(63.8 ± 3.1) ％ vs.(70.0 ± 2.5) ％.There was no significant difference on weight ratio of unligated lobes/total liver between C-ALPPS group and C-PVL group at each time point (P ＜ 0.05).There was significant difference on the alanine transaminase (ALT),aspartate aminotransferase (AST) and albumin (ALB) levels between cirrhosis group and normal group at 4 and 7 days after operation (P ＜ 0.05).The expression level of Ki-67 in cirrhosis group was significantly lower than that in normal group at each time point (P ＜ 0.05).The expression level of Ki-67 in group C-ALPSS and group N-ALPPS at 2nd,4th and 7th day after operation were (19.4 ± 4.8)％ vs.(84.1 ±8.9)％,(33.6±3.5)％ vs.(70.2±7.2)％,(20.2±2.5)％ vs.(50.7±4.4) ％,and the expression level of Ki-67 in group C-PVL and group N-PVL at 2nd,4th and 7th day postoperationwere (21.1±4.0)％ vs.(52.1 ±7.3)％,(32.4 ±5.9)％ vs.(35.6 ±5.3)％,(15.5± 4.6) ％ vs.(12.2 ±4.9) ％.There was no significant difference of Ki-67 levels between C-PVL group and C-ALPPS group at 2 and 4 days after operation (P ＜ 0.05).Conclusions In normal rats,the liver regeneration rate after ALPPS was significantly higher than that after PVL.The liver regeneration rate after ALPPS in cirrhotic rats was significantly lower than that in normal rats after ALPPS.There was no significant difference of the liver regeneration rate between ALPPS and PVL in cirrhotic rats.