Vascular anatomy of the rat liver and its implications for extended hepatectomy and the determination of the minimal liver mass [Elektronische Ressource] / vorgelegt von Nodir Madrahimov

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• Publié par: universitat_duisburg-essen
• Publié le: 01 janvier 2005
• Nombre de lectures: 28
• Langue: English
• Poids de l'ouvrage: 33 Mo

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Vascular anatomy of the rat liver
and its implications for extended hepatectomy
and the determination of the minimal liver mass



























Nodir Madrahimov
Medizinische Fakultät
der
Universität Duisburg-Essen


Klinik für Allgemeinchirurgie, Viszeral- und Transplantationschirurgie



Vascular anatomy of the rat liver
and its implications for extended hepatectomy
and the determination of the minimal liver mass




Inaugural-Dissertation
zur
Erlangung des Doktorgrades der Medizin
durch die Medizinische Fakultät
der Universität Duisburg-Essen


Vorgelegt von
Nodir Madrahimov
aus Tashkent, Uzbekistan
2005

























Dekan: Univ.-Prof. Dr. rer.nat. K-H. Jöckel
1. Gutachter: Priv.-Doz.Dr.med. U.Dahmen
2. Gutachter: Univ.-Prof. Dr. med. G.Gerken
3. Gutachter: Prof. Dr.med. J.Klempnauer, Hannover
Tag der mündlichen Prüfung: 19.Januar, 2006 CONTENT
1. Introduction .................................................................................................................3
1.1. Extended hepatectomy in clinical surgery.............................................................3
1.1.1. Rising need for extended hepatectomy..........................................................3
1.1.2. Extended hepatectomy in living liver donation ...............................................4
1.2. Extended hepatectomy in experimental surgery ...................................................6
1.2.1. Controversial results after extended hepatectomy .........................................6
1.2.2. Surgical techniques .......................................................................................6
2. Hypothesis and aim.....................................................................................................7
2.1. Hypothesis............................................................................................................7
2.2. Aim.......................................................................................................................8
3. Material and methods..................................................................................................9
3.1. Experimental design.............................................................................................9
3.1.1. Visualization of rat liver anatomy as a basis for optimizing the surgical
technique.................................................................................................................9
3.1.2. Influence of surgical technique on outcome after 90% hepatectomy..............9
3.1.3. Application of optimized technique for further reduction (95% and 97%) of
liver mass ..............................................................................................................11
3.2. Animals ..............................................................................................................11
3.3. 3-D Models.........................................................................................................12
3.3.1. Plastination..................................................................................................12
3.3.2. Corrosion cast .............................................................................................12
3.4. Surgical procedures............................................................................................13
3.4.1. Anesthesia...................................................................................................13
3.4.2. Extent, model and technique of liver resection.............................................13
3.4.3. Postoperative management .........................................................................21
3.4.4. Euthanasia and sampling procedure............................................................21
3.5. Clinical outcome .................................................................................................21
3.5.1. Survival........................................................................................................21
3.5.2. Clinical condition..........................................................................................22
3.5.3. Body weight loss..........................................................................................23
3.6. Assessment of liver damage...............................................................................23
3.6.1. Liver function ...............................................................................................23
3.6.2. Liver histology..............................................................................................23
3.6.3. Mass necrosis..............................................................................................24
3.7. Assessment of liver regeneration........................................................................26
3.7.1. Relative increase in liver weight...................................................................26
3.7.2. Proliferation index........................................................................................27
3.8. Data analysis and statistics ................................................................................28
4. Results......................................................................................................................29
4.1. Visualization of rat liver anatomy and consequences for optimizing the vessel
oriented resection technique......................................................................................29
4.1.1. Lobar anatomy.............................................................................................29
4.1.2. Portal vein....................................................................................................32
4.1.3. Hepatic veins ...............................................................................................35
1 4.1.4. Technical considerations for resection of each lobe based on anatomical
findings..................................................................................................................38
4.2. Influence of surgical technique on outcome after 90% hepatectomy...................39
4.2.1. Prospective study regarding influence of technique on outcome..................39
4.2.2. Confirmation of results in retrospective study...............................................48
4.3. Application of optimized technique for further reduction (95% and 97%) of liver
mass .........................................................................................................................54
4.3.1. Clinical outcome ..........................................................................................54
4.3.2. Liver damage...............................................................................................58
4.3.3. Liver regeneration........................................................................................60
5. Discussion:................................................................................................................64
5.1. Analysis..............................................................................................................65
5.1.1. Meta-analysis of results after 90% PH .........................................................65
5.1.2. Comparison of surgical techniques used for 90%PH ...................................67
5.2. Experimental approach.......................................................................................69
5.2.1. Anatomical considerations...........................................................................69
5.2.2. Comparison of surgical techniques ..............................................................76
5.2.3. Extending the extended hepatectomy..........................................................81
6. Summary:..................................................................................................................85
7. Reference list: ...........................................................................................................86
8. Abbreviation: .............................................................................................................93
9. Acknowledgement:....................................................................................................95
10. Curriculum vitae: .....................................................................................................97














2 1. Introduction
1.1. Extended hepatectomy in clinical surgery
1.1.1. Rising need for extended hepatectomy
Surgical removal of the tumor remains the only realistic treatment offering the prospect
of cure for hepatocellular cancer. This may be achieved, either by hepatic resection or
complete hepatic removal with liver replacem