Regional and general effects of hepatic lobes with impaired blood flow after hepatic resection

BACKGROUND/AIMS: In hepatic surgery, blood flow to some parts of the liver may become impaired. At present, no consensus has been reached on ways to treat such affected parts of the liver with impaired blood supply. METHODOLOGY: After the ligation of branches of rat's hepatic artery and/or portal vein, the ligated and non-ligated lobes were studied at fixed intervals up to 84 days. Parameters include hepatic tissue blood flow assessed by a laser Doppler flowmeter, liver regeneration ability using bromodeoxyuridine, apoptosis using anti-single-stranded DNA Ig-G antibody, and vulnerability to an endotoxic injection. RESULTS: Hepatic artery ligation group showed no obvious changes in either the ligated or non-ligated lobes, and these lobes had no effects on the whole body. Of the portal vein ligation group, although the ligated lobes underwent marked atrophy, the compensatory hypertrophy of the non-ligated lobes took place sufficiently and no life-threatening conditions were observed. With regard to the hepatic artery/portal vein ligation (HA/PVL) group, hepatic blood flow in the ligated lobes rapidly decreased, and all hepatocytes underwent necrosis 1 day after surgery. In the non-ligated lobes, however, significant increases in the bromodeoxyuridine labeling index were detected at 1, 2, and 3 days after surgery, and compensatory hypertrophy was recognized. Indocyanine green 15-minute retention rate rapidly increased 1 day after surgery, and there were significant differences compared to the sham group up to 7 days after surgery. The postsurgical mortality rate in the HA/PVL group was significantly high at 13%, and mortality rate following endotoxin injection was as high as 75%. CONCLUSIONS: Affected parts of the liver with blockage of both the hepatic artery and portal vein should be resected.