Rodríguez Aurora, Taurà Pilar, García Domingo Maria I, Herrero Eric, Camps Judith, Forcada Pilar, Sabaté Sergi, Cugat Esteve
Department of Anesthesiology, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
Department of Anesthesiology, Liver Surgery and Liver Transplant Unit, Hospital Clinic, Barcelona University, Barcelona, Spain.
Surgery. 2015 Feb;157(2):249-59. doi: 10.1016/j.surg.2014.09.005.
Ischemic preconditioning (IPC) and anesthetic preconditioning (APC) have been reported to attenuate ischemia-reperfusion (IR) injury after liver resection under continuous inflow occlusion. This study evaluates whether these strategies enhance hepatic protection of remnant liver against IR after liver resection with intermittent clamping (INT).
A total of 106 patients without underlying liver disease and submitted to liver resection using INT were randomized into 3 groups: IPC (10 minutes of inflow occlusion followed by 10 minutes of reperfusion before liver transection), APC (sevoflurane administration for 20 minutes before liver transection), and INT (no preconditioning). Patients were also stratified according to the extent of the hepatectomy. Cytoprotection was evaluated by comparing hepatocyte and endothelial dysfunction markers, apoptosis, histologic lesions, and postoperative outcome.
No differences were observed in preoperative chemotherapy and steatosis, total warm ischemia time, operative time, or blood loss. Kinetics of transaminases (aspartate aminotransferase, P = .137; alanine aminotransferase, P = .616), bilirubin (P = .980), and hyaluronic acid increase (P = .514) revealed no differences. Significant apoptosis was present in 40% of patients, mild-to-moderate leukocyte infiltration and steatosis in 45% and 55%, respectively, and mild sinusoidal congestion in 65%, with a similar distribution in the 3 groups. When patients were stratified by major versus minor resections, no differences were observed in any of the variables studied. Postoperative clinical outcomes were also similar.
These results suggest that these protocols of IPC and APC used in this study do not provide better cytoprotection from IR when INT is used.
据报道，缺血预处理（IPC）和麻醉预处理（APC）可减轻持续血流阻断下肝切除术后的缺血再灌注（IR）损伤。本研究评估这些策略是否能增强间歇性阻断（INT）肝切除术后残余肝脏对IR的保护作用。
总共106例无潜在肝脏疾病且接受INT肝切除术的患者被随机分为3组：IPC组（肝横断前10分钟血流阻断，随后10分钟再灌注）、APC组（肝横断前给予七氟醚20分钟）和INT组（未进行预处理）。患者还根据肝切除范围进行分层。通过比较肝细胞和内皮细胞功能障碍标志物、细胞凋亡、组织学损伤和术后结果来评估细胞保护作用。
术前化疗和脂肪变性、总热缺血时间、手术时间或失血量方面未观察到差异。转氨酶（天冬氨酸转氨酶，P = 0.137；丙氨酸转氨酶，P = 0.616）、胆红素（P = 0.980）和透明质酸升高的动力学（P = 0.514）显示无差异。40%的患者存在明显的细胞凋亡，45%和55%的患者分别有轻度至中度白细胞浸润和脂肪变性，65%的患者有轻度窦状隙充血，3组分布相似。当按大手术与小手术切除对患者进行分层时，所研究的任何变量均未观察到差异。术后临床结果也相似。
这些结果表明，本研究中使用的这些IPC和APC方案在采用INT时并不能提供更好的IR细胞保护作用。
