Protective effect of ischemic preconditioning against ischemia reperfusion injury after major hepatectomy using intermittent Pringle's maneuver in swine

目的：尽管已有报道称连续Pringle's手法对肝切除术后肝损伤有保护作用，但目前尚不清楚间歇性Pringle's手法对肝切除术后缺血预处理（IPC）是否有保护作用。材料与方法：选用体重20 ~ 28kg的公白猪，n=10头。在全麻下行剖腹手术。为防止门静脉和肝动脉长时间阻塞时肠道充血，在右颈内静脉和脾主静脉之间建立静脉-静脉旁路。左半肝切除术（约40%）在肝切除术中按Pringle手法（15分钟夹紧和5分钟释放）进行。IPC组（n=5）：肝缺血10 min，再灌注10 min，在间歇Pringle’s手法前进行IPC。无IPC组（n=5）：肝切除术时肝只进行间歇性普林格氏手法治疗。通过血流动力学监测和生化检查评估两组患者肝切除术后肝损害情况。再灌注后测定血清GOT、GPT、LDH、透明质酸、乳酸、NOx、tnf - α。再灌注180分钟后观察组织学和细胞凋亡结果。统计学分析采用方差分析。所有数值均以平均值±SD表示。结果：两组患者体重、出血量、血流动力学、Pringle’s手法时间及切除肝重量均无显著差异。IPC显著降低血清转氨酶水平（GOT:IPC:135.8±13.5 vs非IPC:199±16.8 P=0.018）和血浆tnf - α水平（IPC:225.3±60.1 vs非IPC:760.4±437.7，P=0.042）。IPC组血清LDH、乳酸、透明质酸、NOx水平升高虽低于非IPC组，但两组间差异无统计学意义。在肝组织中，IPC组tunel阳性细胞明显减少。在所有LPC中，核染色质凝聚存在于肝细胞中。结论：间断性Pringle手法下IPC对再灌注损伤肝切除术有一定的抑制作用。少

Aim : Although ischemic preconditioning(IPC) has been reported to protect liver injury after hepatectomy using continuous Pringle's maneuver, it has not been clarified whether IPC protects liver against injury after hepatectomy using intermittent Pringle's maneuver. Materials and Methods : Male white swines (BW:20〜28kg;n=10) were used. Laparotomy using by chevron incision was performed under general anesthesia. To prevent intestinal congestion during prolonged occlusion of the portal vein and hepatic artery, veno-veno bypass was created between the right internal jugular vein and the main splenic vein. Left hemihepatectomy (approximately, 40%) was performed under Pringle's maneuver (15 min-clamp and 5 min-release) during hepatic resection. IPC group (n=5) : livers were subjected to IPC (hepatic ischemia for 10 min followed by reperfusion for 10 min) before intermitted Pringle's maneuver. None IPC group (n=5) : livers were subjected to only intermitted Pringle's maneuver during hepatect … More omy. Liver damage after hepatectomy was evaluated between the two groups by monitoring hemodynamics and biochemical examination. Serum GOT,GPT,LDH, hyaluronic acid, lactic acid, NOx, TNF-alpha were mesured after reperfusion. Histological and apoptotic findings were also evaluated after reperfusion for 180 min. Statistical analysis was performed using ANOVA. All values are expressed as means ±SD. Result : There were no significant differences in body weight, blood loss, hemodynamics, Pringle's maneuver time and resected liver weight between the two groups. IPC significantly reduced serum transaminase level (GOT:IPC:135.8±13.5 vs non IPC:199±16.8 P=0.018) and plasma TNF-alpha level (IPC:225.3±60.1 vs non IPC:760.4±437.7,P=0.042). Although serum level of LDH, lactic acid, hyaluronic acid and NOx in IPC group were elevated less than those in non-IPC group, there were no statically significantly difference between the two groups. In hepatic tissue, TUNEL-positive cells were significantly reduced in the IPC group. In none LPC, nuclear chromatin condensation is present in the hepatocyte. Conclusions : IPC exerts a effect against reperfusion injury hepatectomy with intermitted Pringle's maneuver. Less