First Department of Anesthesiology, Aretaieion Hospital, University of Athens School of Medicine, Vassilissis Sofias 76, 11528, Athens, Greece.
World J Surg. 2012 Dec;36(12):2895-900. doi: 10.1007/s00268-012-1779-6.
There is evidence that small-for-size liver grafts are more vulnerable to ischemia/reperfusion injury after liver transplantation. We hypothesized that ischemic injury is more pronounced in small liver remnants after major hepatectomies.
Fifteen patients underwent extended hepatectomy with remnant liver mass less than 30% of standard liver weight (study group). These patients were matched with patients who underwent minor liver resection, with liver remnants equal to or more than 70% of standard liver weight (control group). Ischemia/reperfusion injury was assessed by tissue caspase-3 activity postoperatively as well as peak aspartate aminotransferase (AST) values and a-glutathione S-transferase (α-GST) levels adjusted for remnant liver weight. In addition, caspase-3 activity and adjusted serum markers of hepatocyte injury were correlated with the degree of postoperative portal hypertension.
Caspase-3 activity was higher in patients with small liver remnants (22.66±6.57 vs. 12.60±4.06 count per high-power field, p<0.001). Serum markers of hepatocyte injury, when adjusted per gram of liver remnant, were found to be higher in the study group than in the control group (AST: 1.26±0.25 vs. 0.54±0.11 IU g(-1), p<0.001; α-GST: 0.14±0.02 vs. 0.08±0.01 IU g(-1), p<0.001). Tissue caspase-3 expression in the small liver remnant group correlated with both AST and α-GST levels adjusted per gram of liver remnant (r2=0.51, p=0.005 and r2=0.71, p<0.001, respectively). Significant correlations between postoperative portal hypertension and the same markers as well as caspase-3 activity were also demonstrated.
Liver remnants less than 30% of standard liver weight are much more susceptible to ischemia/reperfusion injury than controls twice the size. Adjustment of serum markers of hepatocyte injury to the liver remnant weight depicts injury more accurately.
有证据表明，小体积肝移植物在肝移植后更容易受到缺血/再灌注损伤。我们假设，在大肝切除术后，小肝残余物的缺血损伤更为明显。
15 名患者接受了肝切除术，残余肝质量小于标准肝重量的 30%（研究组）。这些患者与接受了小肝切除术、肝残余量等于或大于标准肝重量的 70%的患者相匹配（对照组）。术后通过组织半胱天冬酶-3 活性以及调整肝残余量后的峰值天冬氨酸氨基转移酶（AST）值和α-谷胱甘肽 S-转移酶（α-GST）水平来评估缺血/再灌注损伤。此外，还将半胱天冬酶-3 活性和调整后的血清肝细胞损伤标志物与术后门静脉高压的程度相关联。
小肝残余物患者的半胱天冬酶-3 活性更高（22.66±6.57 与 12.60±4.06 每高倍视野计数，p<0.001）。当按每克肝残余物调整时，研究组的血清肝细胞损伤标志物高于对照组（AST：1.26±0.25 与 0.54±0.11 IU g(-1)，p<0.001；α-GST：0.14±0.02 与 0.08±0.01 IU g(-1)，p<0.001）。小肝残余物组的组织半胱天冬酶-3 表达与按每克肝残余物调整后的 AST 和 α-GST 水平均相关（r2=0.51，p=0.005 和 r2=0.71，p<0.001）。还证明了术后门静脉高压与相同标志物以及半胱天冬酶-3 活性之间存在显著相关性。
小于标准肝重量 30%的肝残余物比对照组（两倍大小）更容易受到缺血/再灌注损伤。调整血清肝细胞损伤标志物至肝残余物重量可更准确地描述损伤。
