• H Manase.
• Second Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
• Hokkaido Igaku Zasshi. 1999 Jan 1; 74 (1): 19-30.

AbstractWe performed an experimental study in dogs with 40% hepatectomy to prove the efficacy and safety of arterio-portal shunt (APS). Forty-two adult mongrel dogs were used for the experiments. After dearterialization of all the collateral arteries to the liver, the dogs were divided into 3 groups. In Group 1, dearterialization of the hepatic artery, 40% hepatectomy and APS were performed; in Group 2, only 40% hepatectomy was performed, and in Group 3, dearterialization of the hepatic artery and 40% hepatectomy were performed. APS was constructed by anastomosing the common hepatic artery with the portal vein. The hepatic hemodynamics, oxygen delivery and consumption were evaluated, and biochemical and histological studies were carried out in each group. The study consisted of a short-term (48-hour; Experiment 1) and a medium-term (4-weeks; Experiment 2) observations. In Experiment 2, liver regeneration was additionally examined. In Experiment 1, Group 1 and Group 2 showed almost the same findings in all the 4 examination points. However, in Group 3, postoperative oxygen delivery and consumption significantly decreased, and biochemical and histological examinations evidenced the significant liver failure. These results show that APS is capable of preventing postoperative liver failure during the short-term observation period and can substitute for reconstruction of the hepatic artery. Experiment 2 was intended for a longer follow-up of Experiment 1. However, Group 3 did not survive longer than 1 week and was thus excluded. In Group 1 and Group 2, findings on the 4 examinations remained alike for p.o. 4 weeks. And, the two groups regained the preoperative liver weight, respectively, at p.o. 4 weeks. The number of PCNA (proliferating cell nuclear antigen)-positive hepatocytes significantly increased at p.o. 1 week in both groups. These findings revealed that regeneration of the liver in Group 1 with APS was equivalent to that in Group 2 with mere hepatectomy for p.o. 4 weeks at least. These results indicate that liver failure can be averted by constructing APS in hepatectomy cases where reconstruction of the hepatic artery is impossible.

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