Improvement of morphological changes after 70% hepatectomy with portocaval shunt: preclinical study in porcine model.
BACKGROUND
After extensive hepatectomy, excessive portal venous flow (PVF) and elevated portal venous pressure (PVP) may lead to postoperative liver damage. We have evaluated the use of portocaval shunt (PCS) to control PVF and PVP following partial hepatectomy (PH) to reduce the postoperative liver damage.


METHODS
Twenty-four pigs were divided into two Groups: Group C (n = 10) underwent 70% PH alone and Group S (n = 14) underwent 70% PH with PCS. The changes in PVF, PVP, serum liver function tests, and histology were evaluated.


RESULTS
PVP and PVF per unit of remnant liver weight and serum total bilirubin levels in Group S were significantly lower than those in Group C postoperatively (P < 0.05). Histology showed that there were significant differences in hepatocyte ballooning, necrosis, and neutrophil aggregation between the two groups (P < 0.05). In particular, hepatic necrosis was observed in zone 3 of Group C as centrilobular necrosis. These results suggest that hepatic and sinusoidal damage after 70% PH were more severe in Group C than in Group S, with the latter group maintaining an almost normal ultrastructural appearance. Hepatocyte apoptotic index differed significantly between the two groups (P < 0.0001).


CONCLUSIONS
After 70% PH, extensive centrolobular necrosis and neutrophil aggregation were present and may have caused liver damage, manifested as hyperbilirubinemia and coagulopathy. The delayed liver regeneration with PCS may reduce the postoperative liver damages rather than the rapid liver hypertrophy. The diversion of PVF with PCS to maintain adequate PVP is a very effective procedure for avoiding the postoperative liver failure after extensive hepatectomy.
Iida
Taku
T
First Department of Surgery, Mie University, Tsu, Japan. itaku@clin.medic.mie-u.ac.jp
Yagi
Shintaro
S
Taniguchi
Kentaro
K
Hori
Tomohide
T
Uemoto
Shinji
S
D000818:Animals; D001706:Biopsy; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D022781:Hepatocytes / Q000473:pathology / Q000648:ultrastructure; D008099:Liver / Q000473:pathology / Q000502:physiology / Q000601:surgery; D008111:Liver Function Tests; D008115:Liver Regeneration; D008854:Microscopy, Electron; D008928:Mitochondria / Q000473:pathology / Q000648:ultrastructure; D008933:Mitochondrial Swelling; D023421:Models, Animal; D009336:Necrosis; D009929:Organ Size; D011167:Portacaval Shunt, Surgical; D011169:Portal Vein / Q000502:physiology; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control*; D034421:Sus scrofa