Influence of Hepatectomy Combined with Internal Biliary Drainage in Obstructive Jaundice Rats_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Bin ¹ , LIU Chen ¹ , YI Bin ¹ , LUO Xiangji ¹ , GAO Chunfang ² , XU Qiangzhi ³ , YU Yong ¹ ,  JIANG Xiaoqing. ¹

1.Department of Biliary Duct Surgery Ⅰ, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China;;
2.Department of Laboratory Medicine, Eastern Hepatobiliary Surgery, The Second Military Medical University, Shanghai 200438, China;;
3.Department of Biochemistry and Molecular Biology, The Second Military Medical University, Shanghai 200438, China;

Corresponding author：

JIANG Xiaoqing., Email: jxq1225@sina.com

Keywords：

Obstructive jaundice; Hyperbilirubinemia; Hepatectomy; Internal biliary drainage

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ObjectiveTo study the effectiveness of liver function, hepatic energy metabolism, regeneration, and apoptosis on the obstructive jaundice rat after partial hepatectomy (PH) combined with internal biliary drainage under the condition of conspicuous bilirubinemia. MethodsOne hundred and twenty male SD rats were used in research, six of whom were divided into sham operation (SO) group. Twenty rats underwent bridge operation between common bile duct and duodenum after 70% PH (70%PH group), and 6 rats out of the 94 rats who underwent common bile duct ligation (CBDL) for 5 d were randomly selected as CBDL group, and the residual rats were done the second operations after 5 d and were divided into three groups: bile duct obstruction combined with reperfusion of bile flow group （BDO-RBF group， n=20), 42% PH with BDO-RBF group (n=20), and 70%PH with BDO-RBF group (n=25). Levels of TB, ALT, ALB, and ALP in serum; HGF, bcl-2 mRNA and protein； ATP, ADP, and AMP; hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation (24 h, 72 h, and 7 d), respectively. The liver function and hepatocyte energy metabolism were only detected in the SO group. ResultsRats without obstructive jaundice would have an excellent liver regeneration after 70% PH, while the liver function and hepatocyte energy metabolism could recover rapidly. The liver function, hepatocyte energy metabolism, HGF and bcl-2 mRNA and protein of liver tissue and the hepatocyte proliferation/apoptosis index in partial (42% or 70%) hepatectomy combined with internal biliary drainage in obstructive jaundice group were significantly influenced while recovered rapidly (P lt;0.05). ConclusionsUnder the condition of conspicuous bilirubinemia, the influences of hepatectomy combined with internal biliary drainage on hepatocyte energy metabolism, liver function, hepatocyte regeneration and apoptosis are severer than that of normal rats who underwent 70% hepatectomy, while also make the rats recover rapidly in hyperbilirubinemia groups. The database suggest that it is not necessary to do preoperative external biliary drainage before performing liver resection.

Citation： LI Bin,LIU Chen,YI Bin,LUO Xiangji,GAO Chunfang,XU Qiangzhi,YU Yong,JIANG Xiaoqing.. Influence of Hepatectomy Combined with Internal Biliary Drainage in Obstructive Jaundice Rats. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1271-1277. doi: Copy

1.	Witzigmann H, Berr F, Ringel U, et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection [J]. Ann Surg, 2006, 244(2): 230239.
2.	Heimbach JK, Gores GJ, Haddock MG, et al. Predictors of disease recurrence following neoadjuvant chemoradiotherapy and liver transplantation for unresectable perihilar cholangiocarcinoma [J]. Transplantation, 2006, 82(12): 17031707.
3.	Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes [J]. J Am Coll Surg, 2007, 204(2): 250260.
4.	程庆保, 张柏和, 张永杰, 等. 肝门部胆管癌预后因素分析 [J]. 肿瘤, 2005, 25(2): 166169.
5.	张永杰, 俞文隆, 黄立嵩, 等. 联合肝叶切除及区域淋巴清扫治疗肝门部胆管癌的初步观察 [J]. 外科理论与实践, 2005, 10(4): 323327.
6.	Kondo S, Hirano S, Ambo Y, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study [J]. Ann Surg, 2004, 240(1): 95101.
7.	Povoski SP, Karpeh MS Jr, Conlon KC, et al. Preoperative biliary drainage: impact on intraoperative bile cultures and infectious morbidity and mortality after pancreaticoduodenectomy [J]. J Gastrointest Surg, 1993, 3(5): 496505.
8.	Sohn TA, Yeo CJ, Cameron JL, et al. Do preoperative biliary stents increase postpancreaticoduodenectomy complications? [J]. J Gastrointest Surg, 2000, 4(3): 258267.
9.	Pisters PW, Hudec WA, Hess KR, et al. Effect of preoperative biliary decompression on pancreaticoduodenectomyassociated morbidity in 300 consecutive patients [J]. Ann Surg, 2001, 234(1): 4755.
10.	Martignoni ME, Wagner M, Krhenbühl L, et al. Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy [J]. Am J Surg, 2001, 181(1): 5259.
11.	Srivastava S, Sikora SS, Kumar A, et al. Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage [J]. Dig Surg, 2001, 18(5): 381387.
12.	Sewnath ME, Karsten TM, Prins MH, et al. A metaanalysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice [J]. Ann Surg, 2002, 236(1): 1727.
13.	Cherqui D, Benoist S, Malassagne B, et al. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage [J]. Arch Surg, 2000, 135(3): 302308.
14.	Mizuta A, Chijiiwa K, Saiki S, et al. Differences in biliary lipid excretion after major hepatectomy in obstructive jaundiced rats with preoperative internal, external, or no biliary drainage [J]. Eur Surg Res, 2002, 34(4): 291299.
15.	Sano T, Ajiki T, Takeyama Y, et al. Internal biliary drainage improves decreased number of gut mucosal T lymphocytes and MAdCAM1 expression in jaundiced rats [J]. Surgery, 2004, 136(3): 693699.
16.	Hayata A, Takeuchi E, Nagino M, et al. Hepatocyte growth factor concentration in rat bile is affected by hepatic resection volume and external biliary drainage [J]. J Surg Res, 1999, 85(1): 7176.
17.	Ueda J, Chijiiwa K, Nakano K, et al. Lack of intestinal bile results in delayed liver regeneration of normal rat liver after hepatectomy accompanied by impaired cyclin Eassociated kinase activity [J]. Surgery, 2002, 131(5): 564573.
18.	Zarnegar R, Michalopoulos GK. The many faces of hepatocyte growth factor: from hepatopoiesis to hematopoiesis [J]. J Cell Biol, 1995, 129(5): 11771180.
19.	Fausto N, Campbell JS, Riehle KJ. Liver regeneration [J]. Hepatology, 2006, 43(2 Suppl 1): S4553.
20.	Takushi Y, Shiraishi M, Nozato E, et al. Expression of antiapoptotic protein, Bcl2, in liver regeneration after a partial hepatectomy [J]. J Surg Res, 2006, 134(1): 93101.
21.	Yamamoto K, Morishita R, Hayashi S, et al. Contribution of Bcl2, but not BclxL and Bax, to antiapoptotic actions of hepatocyte growth factor in hypoxiaconditioned human endothelial cells [J]. Hypertension, 2001, 37(5): 13411348.
22.	韩德五. 肝功能不全//梁扩寰,李绍白. 肝脏病学 [M]. 第2版. 北京: 人民卫生出版社, 2003: 497513.
23.	Guerrieri F, Muolo L, Cocco T, et al. Correlation between rat liver regeneration and mitochondrial energy metabolism [J]. Biochim Biophys Acta, 1995, 1272(2): 95100.
24.	Hochwald SN, Burke EC, Jarnagin WR, et al. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma [J]. Arch Surg, 1999, 134(3): 261266.
25.	Sakata J, Shirai Y, Wakai T, et al. Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma [J]. World J Gastroenterol, 2005, 11(44): 70247027.
26.	Seyama Y, Kubota K, Sano K, et al. Longterm outcome of extended hemihepatectomy for hilar bile duct Cancer with no mortality and high survival rate [J]. Ann Surg, 2003, 238(1): 7383.

1. Witzigmann H, Berr F, Ringel U, et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection [J]. Ann Surg, 2006, 244(2): 230239.
2. Heimbach JK, Gores GJ, Haddock MG, et al. Predictors of disease recurrence following neoadjuvant chemoradiotherapy and liver transplantation for unresectable perihilar cholangiocarcinoma [J]. Transplantation, 2006, 82(12): 17031707.
3. Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes [J]. J Am Coll Surg, 2007, 204(2): 250260.
4. 程庆保, 张柏和, 张永杰, 等. 肝门部胆管癌预后因素分析 [J]. 肿瘤, 2005, 25(2): 166169.
5. 张永杰, 俞文隆, 黄立嵩, 等. 联合肝叶切除及区域淋巴清扫治疗肝门部胆管癌的初步观察 [J]. 外科理论与实践, 2005, 10(4): 323327.
6. Kondo S, Hirano S, Ambo Y, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study [J]. Ann Surg, 2004, 240(1): 95101.
7. Povoski SP, Karpeh MS Jr, Conlon KC, et al. Preoperative biliary drainage: impact on intraoperative bile cultures and infectious morbidity and mortality after pancreaticoduodenectomy [J]. J Gastrointest Surg, 1993, 3(5): 496505.
8. Sohn TA, Yeo CJ, Cameron JL, et al. Do preoperative biliary stents increase postpancreaticoduodenectomy complications? [J]. J Gastrointest Surg, 2000, 4(3): 258267.
9. Pisters PW, Hudec WA, Hess KR, et al. Effect of preoperative biliary decompression on pancreaticoduodenectomyassociated morbidity in 300 consecutive patients [J]. Ann Surg, 2001, 234(1): 4755.
10. Martignoni ME, Wagner M, Krhenbühl L, et al. Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy [J]. Am J Surg, 2001, 181(1): 5259.
11. Srivastava S, Sikora SS, Kumar A, et al. Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage [J]. Dig Surg, 2001, 18(5): 381387.
12. Sewnath ME, Karsten TM, Prins MH, et al. A metaanalysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice [J]. Ann Surg, 2002, 236(1): 1727.
13. Cherqui D, Benoist S, Malassagne B, et al. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage [J]. Arch Surg, 2000, 135(3): 302308.
14. Mizuta A, Chijiiwa K, Saiki S, et al. Differences in biliary lipid excretion after major hepatectomy in obstructive jaundiced rats with preoperative internal, external, or no biliary drainage [J]. Eur Surg Res, 2002, 34(4): 291299.
15. Sano T, Ajiki T, Takeyama Y, et al. Internal biliary drainage improves decreased number of gut mucosal T lymphocytes and MAdCAM1 expression in jaundiced rats [J]. Surgery, 2004, 136(3): 693699.
16. Hayata A, Takeuchi E, Nagino M, et al. Hepatocyte growth factor concentration in rat bile is affected by hepatic resection volume and external biliary drainage [J]. J Surg Res, 1999, 85(1): 7176.
17. Ueda J, Chijiiwa K, Nakano K, et al. Lack of intestinal bile results in delayed liver regeneration of normal rat liver after hepatectomy accompanied by impaired cyclin Eassociated kinase activity [J]. Surgery, 2002, 131(5): 564573.
18. Zarnegar R, Michalopoulos GK. The many faces of hepatocyte growth factor: from hepatopoiesis to hematopoiesis [J]. J Cell Biol, 1995, 129(5): 11771180.
19. Fausto N, Campbell JS, Riehle KJ. Liver regeneration [J]. Hepatology, 2006, 43(2 Suppl 1): S4553.
20. Takushi Y, Shiraishi M, Nozato E, et al. Expression of antiapoptotic protein, Bcl2, in liver regeneration after a partial hepatectomy [J]. J Surg Res, 2006, 134(1): 93101.
21. Yamamoto K, Morishita R, Hayashi S, et al. Contribution of Bcl2, but not BclxL and Bax, to antiapoptotic actions of hepatocyte growth factor in hypoxiaconditioned human endothelial cells [J]. Hypertension, 2001, 37(5): 13411348.
22. 韩德五. 肝功能不全//梁扩寰,李绍白. 肝脏病学 [M]. 第2版. 北京: 人民卫生出版社, 2003: 497513.
23. Guerrieri F, Muolo L, Cocco T, et al. Correlation between rat liver regeneration and mitochondrial energy metabolism [J]. Biochim Biophys Acta, 1995, 1272(2): 95100.
24. Hochwald SN, Burke EC, Jarnagin WR, et al. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma [J]. Arch Surg, 1999, 134(3): 261266.
25. Sakata J, Shirai Y, Wakai T, et al. Catheter tract implantation metastases associated with percutaneous biliary drainage for extrahepatic cholangiocarcinoma [J]. World J Gastroenterol, 2005, 11(44): 70247027.
26. Seyama Y, Kubota K, Sano K, et al. Longterm outcome of extended hemihepatectomy for hilar bile duct Cancer with no mortality and high survival rate [J]. Ann Surg, 2003, 238(1): 7383.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Influence of Hepatectomy Combined with Internal Biliary Drainage in Obstructive Jaundice Rats

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