Kaiho Takashi, Tanaka Toshikazu, Tsuchiya Shunichi, Yanagisawa Shinji, Takeuchi Osamu, Miura Masami, Saigusa Naoki, Kitakata Yusuke, Miyazaki Masaru
Department of Surgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu City, Chiba, Japan 292-8535.
Hepatogastroenterology. 2003 May-Jun;50(51):761-5.
BACKGROUND/AIMS: Temporary inflow occlusion of the portal triad has been used frequently in hepatectomy to minimize bleeding. On the other hand, Pringle's maneuver produces ischemic-reperfusion injury especially in patients with underlying liver disease.
Thirty-seven cases of hepatic resections were performed with intermittent Pringle's maneuver (IP group; n = 17) and in situ hypothermic perfusion (CP group; n = 20). In the CP group, hepatic inflow was continuously occluded, and 4-degree Centigrade Ringer's lactate was administered by drip during resection. Hepatic outflow occlusion was not performed.
All patients tolerated the procedures well. Cold perfusion technique significantly decreased both the times required and the blood loss in hepatectomy (p < 0.05). Serum hyaluronic acid levels gradually increased after the induction of hepatectomy and peaked 10 minutes after reperfusion in the both groups. Thereafter, it decreased and showed a significantly lower level in the CP group until 60 minutes after reperfusion (p < 0.05). Hepaplastin levels remained significantly higher in the CP group one week after operation (p < 0.05).
Using the technique of in situ hypothermic perfusion, we can prolong the ischemic time safely with minimal systemic influence even in cases with underlying liver diseases. This may compare favorably with intermittent Pringle's maneuver in terms of reducing hepatic sinusoidal endothelial cell damage during hepatectomy and reperfusion.
背景/目的：在肝切除术中，门静脉三联征的临时入流阻断术经常被用于减少出血。另一方面，Pringle手法会产生缺血-再灌注损伤，尤其是在患有潜在肝脏疾病的患者中。
对37例肝切除术患者分别采用间歇性Pringle手法（IP组；n = 17）和原位低温灌注（CP组；n = 20）。在CP组中，肝入流持续阻断，切除过程中静脉滴注4摄氏度的乳酸林格液。未进行肝出流阻断。
所有患者对手术耐受良好。冷灌注技术显著减少了肝切除所需时间和失血量（p < 0.05）。两组肝切除术后血清透明质酸水平逐渐升高，并在再灌注后10分钟达到峰值。此后，其水平下降，且在CP组中，直至再灌注后60分钟，其水平显著低于IP组（p < 0.05）。术后1周，CP组的肝促凝血酶原激酶水平仍显著高于IP组（p < 0.05）。
即使在患有潜在肝脏疾病的患者中，采用原位低温灌注技术，我们也能够安全地延长缺血时间，且对全身影响最小。在减少肝切除术及再灌注期间肝窦内皮细胞损伤方面，该技术可能优于间歇性Pringle手法。
