Ungerstedt Johan, Nowak Greg, Ungerstedt Urban, Ericzon Bo-Göran
Department of Physiology and Pharmacology, Karolinska University Hospital, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Liver Transpl. 2009 Mar;15(3):280-6. doi: 10.1002/lt.21690.
Early detection of vascular complications following liver surgery is crucial. In the present study, intrahepatic microdialysis was used for continuous monitoring of porcine liver metabolism during occlusion of either the portal vein or the hepatic artery. Our aim was to assess whether microdialysis can be used to detect impaired vascular inflow by metabolic changes in the liver. Changes in metabolite concentrations in the hepatic interstitium were taken as markers for metabolic changes. After laparotomy, microdialysis catheters were introduced directly into the liver, enabling repeated measurements of local metabolism. Glucose, lactate, pyruvate, and glycerol were analyzed at bedside every 20 minutes, and the lactate/pyruvate ratio was calculated. In the arterial clamping group, the glucose, lactate, glycerol, and lactate/pyruvate ratio significantly increased during the 2-hour vessel occlusion and returned to baseline levels during the 3-hour reperfusion. In the portal occlusion group and in the control group, the measured metabolites were stable throughout the experiment. Our findings show that liver metabolism, as reflected by changes in the concentrations of glucose, lactate, and glycerol and in the lactate/pyruvate ratio, is markedly affected by occlusion of the hepatic artery. Surprisingly, portal occlusion resulted in no major metabolic changes. In conclusion, the microdialysis technique can detect and monitor arterial vascular complications of liver surgery, whereas potential metabolic changes in the liver induced by portal occlusion were not seen in the current study. Microdialysis may thus be suitable for use in liver surgery to monitor intrahepatic metabolic changes.
肝手术后血管并发症的早期检测至关重要。在本研究中，肝内微透析用于在门静脉或肝动脉阻断期间连续监测猪肝代谢。我们的目的是评估微透析是否可用于通过肝脏代谢变化检测血管流入受损情况。肝间质中代谢物浓度的变化被用作代谢变化的标志物。剖腹术后，将微透析导管直接插入肝脏，以便重复测量局部代谢。每20分钟在床边分析葡萄糖、乳酸、丙酮酸和甘油，并计算乳酸/丙酮酸比值。在动脉夹闭组中，在2小时的血管阻断期间葡萄糖、乳酸、甘油和乳酸/丙酮酸比值显著升高，并在3小时的再灌注期间恢复到基线水平。在门静脉阻断组和对照组中，整个实验过程中所测代谢物保持稳定。我们的研究结果表明，葡萄糖、乳酸和甘油浓度以及乳酸/丙酮酸比值的变化所反映的肝脏代谢受到肝动脉阻断的显著影响。令人惊讶的是，门静脉阻断未导致重大代谢变化。总之，微透析技术可检测和监测肝手术的动脉血管并发症，而本研究中未观察到门静脉阻断引起的肝脏潜在代谢变化。因此，微透析可能适用于肝手术中监测肝内代谢变化。
