Jejunectomy can reduce excessively elevated portal pressure after major hepatectomy in beagle dogs.
A number of factors can lead to the life-threatening liver dysfunction in the aftermath of an extended hepatectomy. Prominent among them is the high portal pressure induced by the concentrated flow of the entire stream of portal blood toward the small remnant liver. Twelve beagle dogs were randomly divided into group A (n=6, 70% hepatectomy) and group B (n=6, 70% hepatectomy after jejunectomy). Three dogs in each group were euthanized at 1 or 4 weeks after the operation and examined to evaluate hemodynamic changes, liver functions, and liver histology. One hour after the hepatectomy, the animals in group B exhibited a significantly lower portal pressure (P=0.002) and significantly higher hepatic arterial flow (P=0.004) than the animals in group A. As more time passed, the total hepatic flow and hepatic tissue flow both rose up to levels significantly higher than those in group A (P=0.037 and P=0.025, respectively). The alkaline phosphatase, total protein, albumin, and anti-thrombin III were all significantly better in group B than in group A on the 1st post-operative day. Liver specimens biopsied at 1 h after the hepatectomy showed significantly more swelling of the hepatocytes in group A than in group B. In addition, an immunohistochemical study using the TUNEL method for liver biopsy on the seventh post-operative day revealed numerous positive cells in group A but few in group B. Our results suggest that the portal pressure control by the enterectomy can forestall dysfunction of the remnant liver after extended hepatectomy, especially during the early post-operative period.
Kawano
Youichi
Y
Department of Surgery for Organ Function and Biological Regulation, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan. surg.1@d8.dion.ne.jp
Akimaru
Koho
K
Takubo
Kaiyo
K
Matsumoto
Koshi
K
Yoshida
Hiroshi
H
Mamada
Yasuhiro
Y
Taniai
Nobuhiko
N
Tajiri
Takashi
T
D000818:Animals; D004285:Dogs; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006975:Hypertension, Portal / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D020287:In Situ Nick-End Labeling; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D008102:Liver Circulation; D008297:Male; D009929:Organ Size; D011169:Portal Vein / Q000502:physiology; D011183:Postoperative Complications / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D014690:Venous Pressure