Heizmann Oleg, Loehe F, Volk A, Schauer R J
Department of Surgery, Universitätsspital Basel, Basel, Switzerland.
Eur J Med Res. 2008 Feb 25;13(2):79-86.
Clamping of the portal triad (Pringle maneuver) prevents blood loss during liver resection, but leads to liver injury upon reperfusion. Ischemic preconditioning (IP) has been shown to protect the liver against prolonged ischemic injury in animal models. However, the clinical value of this procedure has not yet been established.
61 Patients undergoing hepatic resection under inflow occlusion were randomized to either to receive (Group-A n = 30) or not to receive (Group-B n = 31) an IP (10 minutes of ischemia followed 10 minutes of reperfusion).
Mean (+/- SD)/ Group-A vs. Group-B. Pringle time of 34 +/- 14 and 33 +/- 12 minutes and the extent of resected liver tissue (2.7 +/- 1.3 vs. 2.7 +/- 1.1 segments) were comparable in both groups. Complications, including death, severe liver dysfunction and biliary leakage occurred in 6 patients of Group-A vs. 14 patients of Group-B (p<0.05). Intraoperative blood loss was significantly lower in Group-A (1.28 +/- 0.91 l vs. 1.94 +/- 0.76 l; p<0.001) with 5 vs. 15 patients requiring transfusions (p<0.01). In a multivariate analysis the duration of the Pringle maneuver (p<0.05) and the absence of preconditioning (p<0.05) were independent predictors for the occurrence of postoperative complications.
IP protects against reperfusion injury, reduces the incidence of complications after hepatic resection under inflow occlusion and is simple to use in clinical practice.
肝门三联征阻断（Pringle手法）可防止肝切除术中失血，但再灌注时会导致肝损伤。在动物模型中，缺血预处理（IP）已被证明可保护肝脏免受长时间缺血损伤。然而，该方法的临床价值尚未确立。
61例在入肝血流阻断下接受肝切除术的患者被随机分为两组，一组接受IP（缺血10分钟后再灌注10分钟，A组，n = 30），另一组不接受IP（B组，n = 31）。
A组与B组相比，平均（±标准差）。Pringle时间分别为34±14分钟和33±12分钟，两组切除的肝组织范围相当（分别为2.7±1.3段和2.7±1.1段）。A组6例患者出现并发症，包括死亡、严重肝功能障碍和胆漏，B组有14例（p<0.05）。A组术中失血量显著低于B组（分别为1.28±0.91升和1.94±0.76升；p<0.001），需要输血的患者分别为5例和15例（p<0.01）。多因素分析显示，Pringle手法的持续时间（p<0.05）和未进行预处理（p<0.05）是术后并发症发生的独立预测因素。
IP可预防再灌注损伤，降低入肝血流阻断下肝切除术后并发症的发生率，且在临床实践中使用简便。
