Ito Koji, Ozasa Hisashi, Noda Yumi, Koike Yuichi, Arii Shigeki, Horikawa Saburo
Division of Pathophysiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
Liver Int. 2007 Apr;27(3):400-7. doi: 10.1111/j.1478-3231.2006.01432.x.
In liver resection, the temporary occlusion of the hepatoduodenal ligament (Pringle maneuver) is often used. However, the maneuver causes severe ischemia/reperfusion injury in the remnant liver. Our aim was to investigate the effects of splenic artery ligation on the liver function in partially hepatectomized rat with the Pringle maneuver.
The Pringle maneuver was conducted for 30 min just before a two-thirds partial hepatectomy. Splenic artery ligation was performed before the Pringle maneuver. The efficacy of splenic artery ligation was assessed by survival, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), recovery of remnant liver weight, and portal pressure.
On day 3, animal survival was four rats of 12 in partially hepatectomized rats with the Pringle maneuver and 10 rats of 12 in the splenic artery ligation-treated partially hepatectomized rats with the Pringle maneuver. A two-thirds partial hepatectomy alone or splenic artery ligation itself did not show any effects on the survival. Compared with partially hepatectomized rats with the Pringle maneuver, splenic artery-ligated animals had lower serum AST and ALT levels, and higher recovery of remnant liver weight. Splenic artery ligation significantly reduced the portal pressure and also decreased the fatality in excessively hepatectomized rats.
Splenic artery ligation ameliorated the remnant liver function in partially hepatectomized rats with the Pringle maneuver and excessively hepatectomized rats. The amelioration may be mediated at least by decreasing portal pressure.
在肝切除术中，常采用肝十二指肠韧带临时阻断（Pringle手法）。然而，该手法会导致残余肝脏发生严重的缺血/再灌注损伤。我们的目的是研究脾动脉结扎对行Pringle手法的部分肝切除大鼠肝功能的影响。
在三分之二部分肝切除术即将开始前，进行30分钟的Pringle手法。在Pringle手法之前进行脾动脉结扎。通过生存率、血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、残余肝脏重量恢复情况和门静脉压力来评估脾动脉结扎的效果。
在第3天，行Pringle手法的部分肝切除大鼠中，12只中有4只存活；而行Pringle手法且接受脾动脉结扎治疗的部分肝切除大鼠中，12只中有10只存活。单纯的三分之二部分肝切除术或脾动脉结扎本身对生存率均无任何影响。与行Pringle手法的部分肝切除大鼠相比，接受脾动脉结扎的动物血清AST和ALT水平较低，残余肝脏重量恢复较高。脾动脉结扎显著降低了门静脉压力，也降低了过度肝切除大鼠的死亡率。
脾动脉结扎改善了行Pringle手法的部分肝切除大鼠和过度肝切除大鼠的残余肝功能。这种改善可能至少是通过降低门静脉压力介导的。
