Prolonged continuous or intermittent vascular inflow occlusion during hemihepatectomy in pigs.
Prolonged continuous or intermittent vascular inflow occlusion during hemihepatectomy in pigs.
复制标题
猪半肝切除术期间长时间连续或间歇性血管流入闭塞。
DOI：
10.1097/00000658-199903000-00011
复制
发表时间：
1999
影响因子：
9
通讯作者：
D. Gouma
中科院分区：
文献类型：
--
作者：
B. V. van Wagensveld;T. V. van Gulik;H. Gelderblom;J. Scheepers;A. Bosma;E. Endert;D. Gouma
目的
在猪的半肝切除模型中，评估肝脏中长时间连续或间歇性血管流入阻断后的缺血和再灌注（I/R）损伤。
背景数据摘要
肝切除术中的大量失血可以通过暂时性血管流入阻断来防止，从而导致残肝的缺血和再灌注损伤。之前，在短暂（90分钟）血管流入闭塞期间仅诱导有限I/R损伤的猪肝切除模型中，作者证明了连续（CNT）闭塞后与间歇（INT）相比I/R损伤减少。对猪进行该肝切除研究以评估长时间（120分钟）CNT或INT闭塞后的I/R损伤。
方法
在猪（37.0 +/- 1.5 kg）中，2小时内的肝脏缺血为CNT（n = 6）或INT（n = 6）（8个连续的12 min缺血和3 min再灌注期），然后再灌注6小时。在缺血的前12分钟内进行左半肝切除术（45.5% +/- 1.4%）。在对照实验中不进行肝蒂夹闭或肝切除（n = 6）。通过肝脏的透明质酸（HA）摄取能力（早期肝窦内皮细胞损伤的参数）和再灌注期间肝内组织pO 2的恢复来评估微血管损伤。肝细胞损伤通过血浆天冬氨酸转氨酶（AST）、丙氨酸转氨酶和乳酸脱氢酶（LDH）浓度进行检测。
结果
再灌注6小时后，与缺血前摄取相比，对照组中的羟乙磺酸摄取没有改变，但两个切除组中均显著减少。然而，与CNT相比，INT闭塞后吸收更多的HA（分别为60.4% +/- 5.6%和39.5% +/-3.7%; ANOVA：p = 0.001）。再灌注6小时后，INT组的肝内组织pO 2分布比CNT组更接近恢复到缺血前状态，这表明INT闭塞后微循环障碍减少。CNT组和INT组再灌注6 h后AST和LDH的释放均显著增加。然而，INT闭塞后的AST水平低于CNT闭塞后（分别为267.0 +/- 74.7 U/l和603.3 +/- 132.4 U/l; p = 0.06）。
结论
在猪长期肝缺血期间，间歇性肝血管流入阻断与连续阻断相比，导致微循环和肝细胞损伤较少。当在肝切除术期间应用长时间的血管流入阻断时，间歇性夹闭是优选的。
OBJECTIVE
To assess ischemia and reperfusion (I/R) injury in a hemihepatectomy model in pigs after prolonged continuous or intermittent vascular inflow occlusion in the liver.
SUMMARY BACKGROUND DATA
Massive intraoperative blood loss during liver resections can be prevented by temporary vascular inflow occlusion, consequently leading to ischemia and reperfusion injury in the remnant liver. Previously, in a pig liver resection model in which only limited I/R injury was induced during brief (90 min) vascular inflow occlusion, the authors demonstrated reduced I/R injury after continuous (CNT) occlusion, compared to intermittent (INT). This liver resection study on pigs was undertaken to assess I/R injury after prolonged (120 min) CNT or INT occlusion.
METHODS
In pigs (37.0 +/- 1.5 kg), liver ischemia during 2 hours was CNT (n = 6) or INT (n = 6) (eight subsequent periods of 12 min ischemia and 3 min recirculation), followed by 6 hours of reperfusion. A left hemihepatectomy (45.5% +/- 1.4%) was performed within the first 12 minutes of ischemia. No hepatic pedicle clamping or liver resection was performed in control experiments (n = 6). Microvascular damage was assessed by hyaluronic acid (HA) uptake capacity of the liver (parameter of early sinusoidal endothelial cell damage) and restoration of intrahepatic tissue pO2 during reperfusion. Hepatocellular damage was tested by plasma concentrations of aspartate aminotransferase (AST), alanine aminotransferase, and lactate dehydrogenase (LDH).
RESULTS
Hyaluronic acid uptake after 6 hours of reperfusion, compared to preischemic uptake, was unaltered in the control group, but was significantly reduced in both resection groups. However, more HA was taken up after INT occlusion, compared to CNT (60.4% +/- 5.6% and 39.5% +/- 3.7%, respectively; ANOVA: p = 0.001). Intrahepatic tissue pO2 distribution after 6 hours of reperfusion more closely returned to preischemic configuration in the INT group than in the CNT group, indicating reduced microcirculatory disturbances after INT occlusion. Release of AST and LDH after 6 hours of reperfusion was significantly increased in both CNT and INT groups. Lower AST levels, however, were found after INT occlusion than after CNT occlusion (267.0 +/- 74.7 U/l and 603.3 +/- 132.4 U/l, respectively; p = 0.06).
CONCLUSIONS
Intermittent hepatic vascular inflow occlusion during prolonged liver ischemia in pigs resulted in less microcirculatory and hepatocellular injury, compared to continuous occlusion. Intermittent clamping is preferable when prolonged periods of vascular inflow occlusion are applied during liver resections.
有证据表明，大鼠肝移植中移植物存活与实质细胞活力无关。
影响因子：
6.2
作者：
Marzi,I;Zhong,Z;Lemasters,JJ;Thurman,RG
通讯作者：
Thurman,RG
透明质酸流出物水平可以预测临床肝移植后的最终移植结果：前瞻性系列。
影响因子：
0.9
作者：
Bronsther,OL;Rao,PN;Pinna,A;Snyder,J;Cowan,S;Kramer,D;Takaya,S;Starzl,TE
通讯作者：
Starzl,TE