目的：建立联合肝脏分割和门静脉结扎（PVL）二步肝切除术（ALPPS）大鼠模型。方法：将健康60只SD雄性大鼠随机均分为PVL组、ALPPS组、假手术组。PVL组行肝左外叶、左中叶、右叶门静脉分支结扎及尾状叶切除，保留肝右中叶分支；ALPPS组在PVL组手术的基础上，将肝左中叶与右中叶在缺血带处离断；假手术组仅游离出门静脉各分支，不结扎。检测大鼠术后肝再生率（HRR）、肝功能情况，以及肝左中叶病理损伤程度与肝右中叶Ki-67的表达。结果：与假手术组比较，ALPPS组、PVL组术后各时间点肝右中叶HRR均明显升高（均P<0.05），且第4、7天ALPPS组肝右中叶HRR明显高于PVL组（155.96% vs. 118.15%；174.86% vs. 133.55%，均P<0.05）。PVL组术后早期肝功能指标好于ALPPS组（均P<0.05），但后期无统计学差异（均P>0.05）。组织病理学检查显示，ALPPS组术后第1天肝左中叶坏死明显多于PVL组；ALPPS组肝右中叶Ki-67表达第2、4天明显高于PVL组（85.36% vs. 61.84%；43.40% vs. 29.06%，均P<0.05）。结论：ALPPS与PVL均能促进肝再生，并且ALPPS比PVL能更快的促进肝再生；成功建立大鼠ALPPS模型，为研究ALPPS肝再生机制及相关并发症奠定了基础。
Establishment of rat model of associating liver partition and portal vein ligation for staged hepatectomy
Objective: To create the animal model of associating liver partition and portal vein ligation (PVL) for staged hepatectomy (ALPPS) in rats. Methods: Sixty healthy male SD rats were equally randomized into PVL group, ALPPS group and sham group. Rats in PVL group underwent ligation of the portal vein branches for the left lateral, left middle, and right lobes of the liver and complete caudate lobe resection, with preservation of the branches for the right middle lobe; rats in ALPPS group underwent the same procedures as those of PVL group combined with parenchyma splitting of the middle lobe of the liver along the ischemic boundary; rats in sham group underwent dissociation of the portal veins without ligation. The postoperative hepatic regeneration rate (HRR) and liver function were determined, and the pathological changes in the left middle lobe of the liver and Ki-67 expression in the right middle lobe of the liver were examined. Results: Compared with sham group, the HRR of the right middle lobe in both ALPPS group and PVL group were significantly higher than that in sham group at any postoperative time point (all P<0.05), and the HRR of the right middle lobe in ALPPS group was significantly higher than that in PVL group on postoperative day (POD) 4 and 7 (155.96% vs. 118.15%; 174.86% vs. 133.55%, both P<0.05). The liver function parameters in PVL group were better than those in ALPPS group at early postoperative stage (all P<0.05), but showed no significant difference in late postoperative stage between the two groups (all P>0.05). Results of histopathological examinations showed that the focal necrosis in the left middle lobe of the liver was more intense in ALPPS group than that in PVL group on POD 1 (P<0.05), and the Ki-67 positive index in the tissue of the right middle lobe in ALPPS group was significantly higher than that in PVL group on POD 2 and 4 (85.36% vs. 61.84%; 43.40% vs. 29.06%, both P<0.05). Conclusion: Both ALPPS and PVL can promote hepatic regeneration, but ALPPS is faster than PVL in promoting hepatic regeneration. A rat model of ALPPS has been successfully established, which may provide a basis for further investigation on the mechanism of ALPPS induced liver regeneration and ALPPS-associated complications.