Continuous assessment of intrahepatic metabolism by microdialysis during and after portal triad clamping.
Continuous assessment of intrahepatic metabolism by microdialysis during and after portal triad clamping.
复制标题
在门三联结钳期间和之后通过微透析连续评估肝内代谢。
DOI：
10.1016/j.jss.2009.11.720
复制
发表时间：
2011
影响因子：
2.2
通讯作者：
G. Nowak
中科院分区：
文献类型：
--
作者：
B. Isaksson;M. D'Souza;U. Jersenius;J. Ungerstedt;L. Lundell;J. Permert;M. Björnstedt;G. Nowak
背景：缺血再灌注损伤是肝脏手术中门静脉三联夹（PTC）的主要问题。微透析允许术中连续监测肝脏组织代谢。我们的目的是评估微透析作为评估PTC对肝切除术患者肝内代谢影响的工具的可行性。方法对肝切除术患者进行肝内微透析。在PTC治疗前、期间和20分钟后分别收集透析液样本。分析葡萄糖、乳酸、丙酮酸（缺血标志物）和甘油（细胞膜损伤标志物），计算乳酸/丙酮酸比值。结果PTC期间，肝内葡萄糖、乳酸和甘油分别从9.1±2.2 mm增加到14.5±2.4mM，从2.2±0.3 mm增加到5.8±0.5mM，从63±14增加到142±28 μM。丙酮酸保持不变，导致乳酸/丙酮酸比值增加（从39±10增加到104±32）。初始再灌注时葡萄糖进一步升高至16.4±2.9mM。再灌注后丙酮酸增加（从93±18 μM增加到138±23 μM），乳酸保持稳定，乳酸/丙酮酸比值恢复正常。初始再灌注时甘油继续升高。结论sptc与肝内代谢改变有关，包括无氧代谢、糖原溶解增加和细胞膜损伤，导致葡萄糖、乳酸、甘油和乳酸/丙酮酸比值升高。微透析易于使用，可以在肝脏手术期间持续监测肝内代谢。
BACKGROUNDIschemia-reperfusion injury is a major concern with portal triad clamping (PTC) in liver surgery. Microdialysis allows continuous intraoperative monitoring of tissue metabolism in the liver. Our aim was to evaluate the feasibility of microdialysis as a tool to assess the intrahepatic metabolic effects of PTC in patients undergoing liver resection.METHODSEleven patients who underwent liver resection were subjected to intrahepatic microdialysis. Dialysis fluid samples were collected before, during, and after a 20-min period of PTC. Glucose, lactate, pyruvate (markers of ischemia), and glycerol (marker of cell membrane damage) were analyzed and the lactate/pyruvate ratio was calculated.RESULTSDuring PTC, intrahepatic glucose, lactate, and glycerol increased from 9.1±2.2 to 14.5±2.4mM, from 2.2±0.3 to 5.8±0.5mM, and from 63±14 to 142±28 μM, respectively. Pyruvate was unchanged, resulting in an increased lactate/pyruvate ratio (from 39±10 to 104±32). During initial reperfusion, glucose further increased to 16.4±2.9mM. Pyruvate increased after reperfusion (from 93±18 to 138±23 μM), while lactate was stable, resulting in a normalized lactate/pyruvate ratio. Glycerol continued to increase during initial reperfusion.CONCLUSIONSPTC was associated with considerable intrahepatic metabolic alterations with anaerobic metabolism, increased glycogenolysis, and cellular membrane damage resulting in increased levels of glucose, lactate, glycerol, and lactate/pyruvate ratio. Microdialysis is easy to use and allows continuous monitoring of intrahepatic metabolism during liver surgery.