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Objective To compare the clinical results of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and open spleen-preserving distal pancreatectomy (OSPDP).Methods From Jan 2014 to Aug 2017,the clinical results of 30 patients undergoing LSPDP were compared with those of 20 OSPDP patients.The postoperative pancreatic fistula rate was the main observation index.Results There was significant difference in operation time [(140.33 ±55.93) min vs.(182.71 ±43.51)min],blood loss [(175.61 ± 180.78) ml vs.(253.51 ± 176.06) ml],postoperative hospital stay [(6.16 ± 7.22) d vs.(8.85 ± 9.36) d],postoperative exhaust [(2.17 ± 1.43) d vs.(3.10 ± 1.89) d],and postoperative feeding time [(2.26 ± 1.78)d vs.(3.42 ±2.01)d] between LSPDP and OSPDP.LSPDP group was better than OSPDP group (all P ＜ 0.05).The rate of postoperative pancreatic fistula (66.7％ vs.70.0％) and overall complications (80％ vs.90.0％) were not statistically different between the two groups.Pancreatic leakage occurred in 20 cases,lung infection in 1 case,peritoneal infection in 1 case and chylous leakage in one case in LSPDP group,while pancreatic leakage in 14 cases,lung infection in 2 cases,and peritoneal infection in 2 cases in OSPDP group,all were cured by conservative therapy.Conclusions LSPDP is a safe,effective,less traumatic and more economic surgical approach for benign cystic tumors located at the body or tail of the pancreas.
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Objective To explore the effect of ectopic splitting combined with portal vein ligation on rat liver regeneration.Methods Sixty Sprague-Dawley rats were randomly divided into four groups (n =15):portal vein ligation group (PVL group),associating liver partition with PVL group (ALPP group),associating spleen partition combined with PVL group (ASPP group) and associating kidney partition combined with PVL group (AKPP group).Hepatic regeneration rate (HRR),ALT,AST and hepatocyte proliferating cell nuclear antigen (PCNA) were detected on the 2nd,4th and 7th day after operation.Results On the 4th and 7th day,in ALPP group,ASPP group and AKPP group,there was an obvious hyperplasia (F =3.750,P ＜ 0.05;F =16.398,P ＜ 0.01) in the right middle lobe of the liver and higher PCNA (F=6.860,P＜0.01;F=3.810,P＜0.05) in the liver tissue than in PVL group.And ALPP group had significantly higher ALT and AST level on the 2nd and 4th day (ALT:F =8.812,F =21.929;AST:F =36.393,F =6.468;P ＜ 0.01).Conclusions Ectopic splitting combined with PVL can significantly promote rat's liver regeneration,possibly by inflammatory response,stress response and high expression of certain cytokines.
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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.