联合肝脏离断和门静脉结扎的二步肝切除术后肝再生机制

曾陶飞; 陈光磊; 刘彩刚; 戴朝六; 徐锋

doi:10.3969/j.issn.1001-5256.2020.10.040

联合肝脏离断和门静脉结扎的二步肝切除术后肝再生机制

DOI: 10.3969/j.issn.1001-5256.2020.10.040

中国医科大学附属盛京医院普通外科

基金项目:

辽宁省自然科学基金项目(20180551193,2020-MS-181)；盛京医院345人才工程计划资助(40B)；

详细信息

中图分类号: R735.7
计量
- 文章访问数: 748
- HTML全文浏览量: 72
- PDF下载量: 94
- 被引次数: 0
出版历程
- 收稿日期: 2020-05-25
- 出版日期: 2020-10-20

Mechanism of liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy

Department of General Surgery,Shengjing Hospital of China Medical University

Research funding:

摘要

摘要: 肝切除术后剩余肝脏(FLR)体积不足常导致肝衰竭等并发症,甚至死亡,是肝脏外科亟需解决的瓶颈问题之一。联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)是近年兴起的二步肝切除术,能够促进FLR迅速再生,但其机制尚未阐述清楚。回顾了国内外近年的研究进展,综述了ALPPS促进肝脏再生的血流动力学因素和体液因素、ALPPS对肝实质细胞的影响以及肝星状细胞、自然杀伤细胞、巨噬细胞、肝干/祖细胞等肝非实质细胞对肝脏再生的调节作用。指出肝非实质细胞与实质细胞间相互作用将是ALPPS术后肝再生机制研究的热点视角。
- 肝切除术 /
- 肝再生 /
- 肝功能衰竭
Abstract: Insufficient volume of future liver remnant( FLR) often leads to the complications including liver failure and even death and thus remains a bottleneck for liver surgery. Associating liver partition and portal vein ligation for staged hepatectomy( ALPPS) is a newly developed two-stage hepatectomy procedure which can promote rapid regeneration of FLR,but the related mechanism has not yet been elucidated. With reference to the recent research advances in China and foreign countries,this article reviews the hemodynamic and humoral factors for ALPPS in promoting liver regeneration,the effect of ALPPS on liver parenchymal cells,and the role of non-parenchymal liver cells( including hepatic stellate cells,natural killer cells,macrophages,and liver progenitor/stem cells) in regulating liver regeneration. It is pointed out that the interaction between non-parenchymal liver cells and parenchymal cells is a hotspot in the research on the mechanism of liver regeneration after ALPPS.
- hepatectomy /
- liver regeneration /
- liver failure

HTML全文

参考文献(41)

[1] MAI RY,YE JZ,BAI T,et al. Advances in the prevention and treatment of posthepatectomy liver failure in patients with primary liver cancer[J]. J Clin Hepatol,2018,34(12):2685-2692.(in Chinese)麦荣云，叶甲舟，白涛，等．原发性肝癌肝切除术后肝衰竭的防治进展[J]．临床肝胆病杂志，2018,34(12):2685-2692.

[2] OLDHAFER KJ,STAVROU GA,van GULIK TM. ALPPS--where do we stand,where do we go?:Eight recommendations from the first international expert meeting[J]. Ann Surg,2016,263(5):839-841.

[3] GIGLIO MC,GIAKOUSTIDIS A,DRAZ A,et al. Oncological outcomes of major liver resection following portal vein embolization:A systematic review and Meta-analysis[J]. Ann Surg Oncol,2016,23(11):3709-3717.

[4] DILI A,BERTRAND C,LEBRUN V,et al. Hypoxia protects the liver from small for size syndrome:A lesson learned from the associated liver partition and portal vein ligation for staged hepatectomy(ALPPS)procedure in rats[J]. Am J Transplant,2019,19(11):2979-2990.

[5] CHAN A,ZHANG WY,CHOK K,et al. ALPPS versus portal vein embolization for hepatitis-related hepatocellular carcinoma:A changing paradigm in modulation of future liver remnant before major hepatectomy[J]. Ann Surg,2019.[Online ahead of print]

[6] SCHADDE E,TSATSARIS C,SWIDERSKA-SYN M,et al.Hypoxia of the growing liver accelerates regeneration[J]. Surgery,2017,161(3):666-679.

[7] LU TT,XU BH,WEN Z,et al. Correlation between portal hemodynamic changes and residual liver volume hyperplasia in patients with massive hepatic carcinoma after associating liver partitioning and portal vein cclusion for staged hepatectomy[J]. Chin J Med Imaging,2019,27(4):273-276,281.(in Chinese)卢婷婷，徐邦浩，文张，等．巨块型肝癌联合肝脏分隔和门静脉结扎的二步肝切除术后门静脉血流动力学变化与剩余肝脏体积增生的相关性[J]．中国医学影像学杂志，2019,27(4):273-276,281.

[8] DEAL R,FREDERIKS C,WILLIAMS L,et al. Rapid liver hypertrophy after portal vein occlusion correlates with the degree of collateralization between lobes-a study in Pigs[J]. J Gastrointest Surg,2018,22(2):203-213.

[9] DHAR DK,MOHAMMAD GH,VYAS S,et al. A novel rat model of liver regeneration:Possible role of cytokine induced neutrophil chemoattractant-1 in augmented liver regeneration[J]. Ann Surg Innov Res,2015,9:11.

[10] TOMASSINI F,D’ASSELER Y,GIGLIO MC,et al. Hemodynamic changes in ALPPS influence liver regeneration and function:Results from a prospective study[J]. HPB(Oxford),2019,21(5):557-565.

[11] SCHLEGEL A,LESURTEL M,MELLOUL E,et al. ALPPS:From human to mice highlighting accelerated and novel mechanisms of liver regeneration[J]. Ann Surg,2014,260(5):839-846.

[12] ROBLES-CAMPOS R,NAVARRO-BARRIOS，MARTNEZCACERES C,et al. The contribution of the deportalized lobe to liver regeneration in tourniquet-ALPPS[J]. Ann Surg,2020,271(3):e94-e96.

[13] JI L,YAN T,REN A,et al. Association of the IL-6/STAT3signaling pathway with liver regeneration induced by associating liver partition and portal vein ligation for staged hepatectomy in mice[J]. J Chongqing Med Univ,2019,44(2):181-186.(in Chinese)季磊，闫挺，任翱，等．IL-6/STAT3信号通路与小鼠联合原位肝劈开和门静脉分支结扎术后肝脏再生的关系[J]．重庆医科大学学报，2019,44(2):181-186.

[14] SPARRELID E,JOHANSSON H,GILG S,et al. Serial assessment of growth factors associated with liver regeneration in patients operated with associating liver partition and portal vein ligation for staged hepatectomy[J]. Eur Surg Res,2018,59(1-2):72-82.

[15] LIU WW,YU F,LIU H,et al. Study on the relationship between remnant liver regeneration and Wnt2 protein expression in rats after ALPPS[J]. J Anhui Med Univ,2017,52(9):1331-1335.(in Chinese)刘伟伟，余锋，刘洪，等．大鼠ALPPS术后残肝再生与Wnt2蛋白表达关系的研究[J]．安徽医科大学学报，2017,52(9):1331-1335.

[16] COLAK D,AL-HARAZI O,MUSTAFA OM,et al. RNA-Seq transcriptome profiling in three liver regeneration models in rats:Comparative analysis of partial hepatectomy,ALLPS,and PVL[J]. Sci Rep,2020,10(1):5213.

[17] BORGER P,SCHNEIDER M,FRICK L,et al. Exploration of the transcriptional landscape of ALPPS reveals the pathways of accelerated liver regeneration[J]. Front Oncol,2019,9:1206.

[18] ESHMUMINOV D,TSCHUOR C,RAPTIS DA,et al. Rapid liver volume increase induced by associating liver partition with portal vein ligation for staged hepatectomy(ALPPS):Is it edema,steatosis,or true proliferation?[J]. Surgery,2017,161(6):1549-1552.

[19] LEHMANN K,TSCHUOR C,RICKENBACHER A,et al. Liver failure after extended hepatectomy in mice is mediated by a p21-dependent barrier to liver regeneration[J]. Gastroenterology,2012,143(6):1609-1619. e1604.

[20] LANGIEWICZ M,SCHLEGEL A,SAPONARA E,et al. Hedgehog pathway mediates early acceleration of liver regeneration induced by a novel two-staged hepatectomy in mice[J]. J Hepatol,2017,66(3):560-570.

[21] BUDAI A,HORVATH G,TRETTER L,et al. Mitochondrial function after associating liver partition and portal vein ligation for staged hepatectomy in an experimental model[J]. Br J Surg,2019,106(1):120-131.

[22] ALEXANDRINO H,VARELA AT,TEODORO JS,et al. Mitochondrial bioenergetics and posthepatectomy liver dysfunction[J]. Eur J Clin Invest,2016,46(7):627-635.

[23] ALEXANDRINO H,ROLO A,TEODORO JS,et al. Bioenergetic adaptations of the human liver in the ALPPS procedurehow liver regeneration correlates with mitochondrial energy status[J]. HPB(Oxford),2017,19(12):1091-1103

[24] PALOMER X,ALVAREZ-GUARDIA D,RODRGUEZ-CALVO R,et al. TNF-alpha reduces PGC-1alpha expression through NF-kappaB and p38 MAPK leading to increased glucose oxidation in a human cardiac cell model[J]. Cardiovasc Res,2009,81(4):703-712.

[25] ALVAREZ-GUARDIA D,PALOMER X,COLL T,et al. The p65 subunit of NF-kappaB binds to PGC-1alpha,linking inflammation and metabolic disturbances in cardiac cells[J].Cardiovasc Res,2010,87(3):449-458.

[26] CHEN L,ZHANG W,ZHOU QD,et al. HSCs play a distinct role in different phases of oval cell-mediated liver regeneration[J]. Cell Biochem Funct,2012,30(7):588-596.

[27] DIRSCHERL K,SCHLAPFER M,ROTH Z’GRAGGEN B,et al.Hypoxia sensing by hepatic stellate cells leads to VEGF-dependent angiogenesis and may contribute to accelerated liver regeneration[J]. Sci Rep,2020,10(1):4392.

[28] LANGIEWICZ M,GRAF R,HUMAR B,et al. JNK1 induces hedgehog signaling from stellate cells to accelerate liver regeneration in mice[J]. J Hepatol,2018,69(3):666-675.

[29] JENNE CN,KUBES P. Immune surveillance by the liver[J].Nat Immunol,2013,14(10):996-1006.

[30] FAUSTO N,CAMPBELL JS,RIEHLE KJ. Liver regeneration[J]. Hepatology,2006,43(2 Suppl 1):s45-s53.

[31] LI N,HUA J. Immune cells in liver regeneration[J]. Oncotarget,2017,8(2):3628-3639.

[32] MARTINEZ FO,GORDON S. The M1 and M2 paradigm of macrophage activation:Time for reassessment[J]. F1000Prime Rep,2014,6:13.

[33] ANANTHA RV,SHALER CR,MEILLEUR CE,et al. The future liver remnant in patients undergoing the associating liver partition with portal vein ligation for staged hepatectomy(ALPPS)maintains the immunological components of a healthy organ[J]. Front Med(Lausanne),2016,3:32.

[34] SUN H,SUN C,TIAN Z,et al. NK cells in immunotolerant organs[J]. Cell Mol Immunol,2013,10(3):202-212.

[34] BI J,ZHENG X,CHEN Y,et al. TIGIT safeguards liver regeneration through regulating natural killer cell-hepatocyte crosstalk[J]. Hepatology,2014,60(4):1389-1398.

[36] HUANG M,HUANG CC,XIAO L,et al. Alteration in intrahepatic stem/progenitor cells after first stage of ALPPS and its relationship to liver regeneration[J]. Chin J Gen Surg,2018,27(2):210-218.(in Chinese)黄民，黄粲宸，肖乐，等．ALPPS一期术后肝内干/祖细胞的变化及其与肝再生的关系[J]．中国普通外科杂志，2018,27(2):210-218.

[37] LIN KH,HSU HT,TENG TH,et al. Rapidly increasing liver progenitor cell numbers in human regenerating liver after portal vein ligation and liver partition[J]. Malays J Pathol,2017,39(3):289-291.

[38] WANG Z,FAN J,ZHOU J. Application prospect of associating liver partition and portal vein ligation for staged hegatectomy in liver surgery[J]. J Hepatobiliary Surg,2015,23(1):1-2.(in Chinese)王征，樊嘉，周俭．ALPPS在肝脏外科的应用前景[J]．肝胆外科杂志，2015,23(1):1-2.

[39] LOPEZ-LOPEZ V,ROBLES-CAMPOS R,BRUSADIN R,et al. ALPPS for hepatocarcinoma under cirrhosis:A feasible alternative to portal vein embolization[J]. Ann Transl Med,2019,7(22):691.

[40] YIFAN T,MING X,YIFAN W,et al. Hepatic regeneration by associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is feasible but attenuated in rat liver with thioacetamide-induced fibrosis[J]. Surgery,2019,165(2):345-352.

[41] XIAO ZQ,HANG J,YU Q,et al. Effects of associating liver partition with portal vein ligation for staged hepatectomy on liver regeneration of rat with liver cirrhosis[J]. Chin J Dig Surg,2018,24(7):476-480.(in Chinese)肖遵强，黄静，于茜，等．联合门静脉结扎及原位肝脏离断二步肝切除对肝硬化大鼠肝脏再生能力的影响[J]．中华肝胆外科杂志，2018,24(7):476-480.

施引文献

资源附件(0)

访问统计