Date Published: January 10, 2020
Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em
Author(s): Thiago Boechat de Abreu, Alexandre de Abreu Ribeiro, Lívia Paola Colchete Provenzano, Joaquim Ribeiro, Alberto Schanaider.
To evaluate liver regeneration after selective ligation of portal vein and
hepatic artery by 3D Computed Tomography in an experimental model.
Sixteen Wistar rats were randomized into four equal groups: Group I- control
(sham), Group II- isolated selective ligation of the hepatic artery, Group
III- isolated selective ligation of the portal vein and Group IV- combined
ligation of portal vein and hepatic artery. Before procedure and five days
after a 3D CT Scan was performed to analyze the hypertrophy, weight and
function of the remnant liver.
The largest regeneration rate and increase of weight in the hypertrophied
lobe was detected in group IV, the first with an average of 3.99 (p=0.006)
and the last varying from 6.10g to 9.64g (p=0.01). However, total liver
weight and the R1 ratio (Hypertrophied Lobe Weight/Total Liver Weight) was
higher in group III (P<0.001) when compared with groups I, II and IV and showed no difference between them. The immunohistochemical examination with PCNA also found higher percentages with statistical significance differences in rats of groups III and IV. It was possible to confirm a strong correlation between hypertrophied lobe weight and its imaging volumetric study. Liver function tests only showed a significant difference in serum gamma-glutamyltransferase and phosphorous. There is a largest liver regeneration after combined ligation of portal vein and hepatic artery and this evidence may improve the knowledge of surgical treatment of liver injuries, with a translational impact in anima nobile.
The first liver surgery was performed just over 100 years ago1. Considered a complex procedure due to the occurrence mainly of bleeding and
biliary fistula, the technique underwent several modifications in this last
century1,2. In addition to technical changes, the emergence of energy devices – as
monopolar, bipolar and radiofrequency energy – and ultrasonic aspiration, allowed
more extensive resections to be performed. All these advances have brought a new
challenge: hepatic failure, which is the most common cause of mortality after
extensive respective liver surgeries1,4.
The research was approved by the Animal Use Ethics Committee of Universidade Federal
do Rio de Janeiro (UFRJ) in accordance with Brazilian legislation and international
guidelines (Process number 87/09). The study was carried out at the Center of
Experimental Surgery, School of Medicine – UFRJ.
There were no deaths caused by the surgical procedure, so it was possible to acquire
all liver measures and laboratory parameters. Likewise, all CT tests and their
reconstructions were successfully performed in all groups.
The acquisition of liver images with 3D CT reconstruction proved to be a reliable
method for measuring the volume of hypertrophied hepatic segments after surgery.
Evidence of rapid and major hepatic regeneration without functional impairment after
a 70% restriction of liver blood flow due to combined ligation of portal vein and
hepatic artery may improve surgical treatment of liver lesions.