Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, France.
Br J Surg. 2011 Sep;98(9):1236-43. doi: 10.1002/bjs.7626. Epub 2011 Jul 11.
Vascular inflow occlusion is effective in avoiding excessive blood loss during hepatic parenchymal transection but may cause ischaemic damage to the remnant liver. Intermittent portal triad clamping (IPTC) is superior to continuous hepatic pedicle clamping as it avoids severe ischaemia-reperfusion (IR) injury in the liver remnant. Ischaemic preconditioning (IPC) before continuous Pringle manoeuvre may protect against IR during major liver resection.
This RCT assessed the impact of IPC in major liver resection with intermittent vascular inflow occlusion. Patients undergoing major liver resection with intermittent vascular inflow occlusion were randomized, during surgery, to receive IPC (10 min inflow occlusion followed by 10 min reperfusion) or no IPC (control group). Data analysis was on an intention-to-treat basis. The primary endpoint was serum alanine aminotransferase (ALT) level on the day after surgery.
Eighty four patients were enrolled and randomized to IPC (n = 41) and no IPC (n = 43). The groups were comparable in terms of demographic data, preoperative American Society of Anesthesiologists grade and extent of liver resection. Intraoperative morbidity and postoperative outcomes were also similar. ALT levels on the day after operation were not decreased by IPC (mean(s.d.) 537·6(358·5) versus 525·0(400·6) units/ml in IPC and control group respectively; P = 0·881). Liver biochemistry tests in the week after operation showed the same pattern in both groups.
IPC did not reduce liver damage in patients undergoing major liver resection with IPTC.
NCT00908245 (http://www.clinicaltrials.gov).
血管入流阻断在避免肝实质切开过程中过度失血方面是有效的，但可能导致残余肝脏缺血损伤。间歇性门静脉三联阻断（IPTC）优于连续肝蒂阻断，因为它避免了肝脏残余物的严重缺血再灌注（IR）损伤。在主要肝切除术前进行缺血预处理（IPC）可能有助于防止主要肝切除术中的 IR。
这项 RCT 评估了 IPC 在间歇性血管入流阻断的主要肝切除术中的影响。接受间歇性血管入流阻断的主要肝切除术患者在手术期间被随机分为接受 IPC（10 分钟入流阻断后 10 分钟再灌注）或不接受 IPC（对照组）。数据分析基于意向治疗。主要终点是术后第一天的血清丙氨酸氨基转移酶（ALT）水平。
84 例患者入组并随机分为 IPC 组（n = 41）和无 IPC 组（n = 43）。两组在人口统计学数据、术前美国麻醉医师协会（ASA）分级和肝切除范围方面具有可比性。术中发病率和术后结局也相似。IPC 并未降低术后第一天的 ALT 水平（IPC 组的平均值（标准差）为 537.6（358.5）单位/ml，对照组为 525.0（400.6）单位/ml；P = 0.881）。两组在术后一周的肝功能检查均表现出相同的模式。
IPC 并未减轻接受 IPTC 的主要肝切除术患者的肝损伤。
NCT00908245（http://www.clinicaltrials.gov）。
