门静脉限流联合肝动脉结扎对肝再生及肝细胞肝癌发展影响的实验研究  

Effect of Portal Vein Restriction Combined with Hepatic Artery Ligation on Liver Regeneration and Development of Hepatocellular Carcinoma in Rats

作　　者：张文卓 侯栋升 李超 王辉 邵永 朱孝成 姚立彬 ZANG Wen-zhuo;HOU Dong-sheng;LI Chao;WANG Hui;SHAO Yong;ZHU Xiao-cheng;YAO Li-bin(Xuzhou Medical University,Xuzhou 221000,China;Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学,江苏徐州221000 [2]徐州医科大学附属医院,江苏徐州221000

出　　处：《肿瘤学杂志》2021年第8期654-660,共7页Journal of Chinese Oncology

基　　金：徐州市科技计划项目重点研发计划(KC17201)。

摘　　要：[目的]研究门静脉限流联合肝动脉结扎对肝再生及肝细胞肝癌发展的影响。[方法]使用McA-RH7777肝癌细胞系悬液原位种植于大鼠肝左叶所成功建立的40只肝细胞肝癌大鼠随机分为假手术组(Sham组)、肝动脉结扎组(HAL组)、门静脉结扎组(PVL组)、门静脉限流+肝动脉结扎组(PVRHAL组),每组10只。Sham组仅做开关腹处理;HAL组和PVL组均先结扎肝乳头叶及右外侧叶和三角叶的门静脉分支,然后对HAL组行肝左动脉结扎,及PVL组行门静脉左支结扎后关腹;PVRHAL组在HAL组的基础上,使用直径为0.6mm细针与门静脉左支捆绑结扎后拔出细针完成限流,关腹。观察术后第7 d各组大鼠肝左叶肿瘤变化及肝中叶增生情况并计算肝再生率,肝脏病理组织学变化及免疫组化结果等。[结果]PVRHAL组肿瘤长径较术前增长(1.60±0.84)mm,VEGF阳性率为26.91%±8.37%,明显低于Sham组[(6.15±2.86)mm,37.69%±8.26%](P=0.039、0.003)和PVL组[(11.80±8.94)mm,39.76%±8.10%](P<0.001,P=0.001),与HAL组[(1.40±1.13)mm,24.24%±5.32%]相比差异无统计学意义(P=0.925、0.439)。PVRHAL组肝中叶重量、肝再生率和Ki-67阳性率分别为(5.78±1.42)g、198.32%±72.13%,50.51%±7.38%,明显高于Sham组[(2.53±0.50)g、30.94%±24.86%,3.14%±1.13%](P均<0.001)及HAL组[(2.93±0.58)g、53.09%±29.83%,3.68%±1.28%](P均<0.001),但低于PVL组[(6.55±1.68)g、232.81%±81.66%,66.14±10.74%;P=0.145、0.191,P<0.001]。[结论]门静脉限流联合肝动脉结扎能够在有效诱导预留侧肝叶代偿性增生的同时抑制阻塞侧肝叶肿瘤(以肝动脉供血为主肝细胞肝癌)的生长。[Objective]To investigate the effect of portal vein restriction combined with hepatic artery ligation on liver regeneration and development of hepatocellular carcinoma in rats.[Methods]Rat hepatocellular carcinoma(HCC)Mc A-RH7777 cells were inoculated in the left lobe of the liver of male AD rats to establish HCC model.Forty HCC rats were randomly divided into Sham operation group(Sham group),hepatic artery ligation group(HAL group),portal vein ligation group(PVL group),and portal vein restriction combined with hepatic artery ligation group(PVRHAL group),with 10 rats in each group.The sham surgery was performed in Sham group;in HAL group and PVL group portal vein branches in the hepatic papillary lobe,right lateral lobe and triangular lobe were ligated,then left hepatic artery ligation was performed in HAL group and left portal vein ligation was performed in PVL group;in the PVRHAL group,on the basis of HAL group,a fine needle with a diameter of 0.6 mm was used to bind and ligate the left portal vein.The tumor size in the left lobe and the hyperplasia of the middle lobe of the liver in each group were observed on d7 after the operation,and the liver regeneration rate,liver histopathological changes and immunohistochemical results were analyzed.[Results]The tumor diameter of PVRHAL group was(1.60±0.84)mm and the positive rate of VEGF was 26.91%±8.37%,which were significantly lower than those of Sham group[(6.15±2.86)mm and 37.69%±8.26%;P=0.039,0.003]and PVL group[(11.80±8.94)mm and 39.76%±8.10%;P<0.001,P=0.001];but had no significant differences with HAL[(1.40±1.13)mm and 24.24%±5.32%;P=0.925,0.439].The median liver weight,liver regeneration rate and ki-67 positive rate in PVRHAL group were(5.78±1.42)g,198.32%±72.13%and 50.51%±7.38%,respectively,which were significantly higher than those in Sham group[(2.53±0.50)g,30.94%±24.86%and 3.14%±1.13%,respectively;all P<0.001]and HAL group[(2.93±0.58)g,53.09%±29.83%and 3.68%±1.28%,respectively;all P<0.001],however,it was lower than those in PVL group[(6.55

关 键 词：门静脉限流 肝动脉结扎 肝再生 肿瘤发展 大鼠 

分 类 号：R735.7[医药卫生—肿瘤]