Minimally Invasive Extended Hepatectomy in Miniature Pigs and the Subsequent Hepatic Regenerative Response

摘要

This study reported a surgical method of laparoscopic extended hepatectomy and changes in the regenerative response. A purely laparoscopic four-port approach was used to perform left hemihepatectomy combined with right lateral lobectomy in miniature pigs. The total incision length was 5.1 cm, the average operative time was 139 min (range: 128-152 min), and the estimated blood loss was 136 ml. The serum total proteinlevel decreased 1 day after surgery, reached its lowest level 3 days and gradually increased from 7 to 14 days after surgery. Aspartate aminotransferase, total bilimbin and gamma-glutamyl transpeptidase levels peaked 1 day after surgery and then gradually decreased from 3 to 14 days after surgery. Histopathological examination revealed hepatocyte proliferation and increased hepatic sinus space in local hepatic lobules 1 day after surgery. Disordered proliferating hepatocytes were identified in the hepatic lobules 3 days after surgery. Seven days after surgery, interstitial fibrous tissue hyperplasia and inflammatory cell infiltration occurred in the liver tissue near the resection. The expression of PCNA in hepatocytes peaked 3 days after surgery and then decreased over time. The expression of the cyclin D1 gene in the liver tissue was significantly increased during the early stage after hepatectomy, with levels significantly higher 1 day after surgery than before surgery (P<0.01); this difference relative to preoperative levels persisted until 3 days after surgery (0.01