HPB and Liver Transplantation, Royal Free Campus, University College London Medical School, Royal Free Hospital, 9th Floor, Pond Street, London, NW3 2QG, United Kingdom.
World J Gastroenterol. 2010 Dec 28;16(48):6098-103. doi: 10.3748/wjg.v16.i48.6098.
During liver resection surgery for cancer or liver transplantation, the liver is subject to ischaemia (reduction in blood flow) followed by reperfusion (restoration of blood flow), which results in liver injury [ischemia-reperfusion (IR) or IR injury]. Modulation of IR injury can be achieved in various ways. These include hypothermia, ischaemic preconditioning (IPC) (brief cycles of ischaemia followed by reperfusion of the organ before the prolonged period of ischaemia i.e. a conditioning response), ischaemic postconditioning (conditioning after the prolonged period of ischaemia but before the reperfusion), pharmacological agents to decrease IR injury, genetic modulation of IR injury, and machine perfusion (pulsatile perfusion). Hypothermia decreases the metabolic functions and the oxygen consumption of organs. Static cold storage in University of Wisconsin solution reduces IR injury and has prolonged organ storage and improved the function of transplanted grafts. There is currently no evidence for any clinical advantage in the use of alternate solutions for static cold storage. Although experimental data from animal models suggest that IPC, ischaemic postconditioning, various pharmacological agents, gene therapy, and machine perfusion decrease IR injury, none of these interventions can be recommended in clinical practice. This is because of the lack of randomized controlled trials assessing the safety and efficacy of ischaemic postconditioning, gene therapy, and machine perfusion. Randomized controlled trials and systematic reviews of randomized controlled trials assessing the safety and efficacy of IPC and various pharmacological agents have demonstrated biochemical or histological improvements but this has not translated to clinical benefit. Further well designed randomized controlled trials are necessary to assess the various new protective strategies in liver resection.
在癌症或肝移植的肝切除术中，肝脏会经历缺血（血流减少），随后再灌注（恢复血流），从而导致肝损伤[缺血再灌注（IR）或 IR 损伤]。可以通过多种方式来调节 IR 损伤。这些方法包括低温、缺血预处理（IPC）（在长时间缺血之前，器官短暂的缺血再灌注循环，即一种预处理反应）、缺血后处理（在长时间缺血之后但在再灌注之前进行的处理）、降低 IR 损伤的药物、IR 损伤的基因调控和机器灌注（脉动灌注）。低温降低了器官的代谢功能和耗氧量。威斯康星大学溶液的静态低温保存减少了 IR 损伤，并延长了器官的储存时间，改善了移植移植物的功能。目前，在静态低温保存中使用替代溶液没有任何临床优势的证据。尽管来自动物模型的实验数据表明 IPC、缺血后处理、各种药物、基因治疗和机器灌注可以降低 IR 损伤，但这些干预措施在临床实践中都不能推荐。这是因为缺乏评估缺血后处理、基因治疗和机器灌注的安全性和疗效的随机对照试验。评估 IPC 和各种药物的安全性和疗效的随机对照试验和系统评价显示了生化或组织学的改善，但这并没有转化为临床获益。需要进一步设计良好的随机对照试验来评估肝切除术中各种新的保护策略。
