Chu Michael J J, Vather Ryash, Hickey Anthony J R, Phillips Anthony R J, Bartlett Adam S J R
Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
Maurice Wilkins Centre for Biodiscovery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand ; School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
Biomed Res Int. 2015;2015:370451. doi: 10.1155/2015/370451. Epub 2015 Feb 10.
Ischemia-reperfusion injury is a major cause of post-liver-surgery complications. Ischemic preconditioning (IPC) has been demonstrated to protect against ischemia-reperfusion injury. Clinical studies have examined IPC in liver surgery but with conflicting results. This systematic review aimed to evaluate the effects of IPC on outcome in clinical liver surgery.
An electronic search of OVID Medline and Embase databases was performed to identify studies that reported outcomes in patients undergoing liver surgery subjected to IPC. Basic descriptive statistics were used to summarise data from individual clinical studies.
1093 articles were identified, of which 24 met the inclusion criteria. Seven topics were selected and analysed by subgroup. There were 10 studies in cadaveric liver transplantation, 2 in living-related liver transplantation, and 12 in liver resection. IPC decreases hepatocellular damage in liver surgery as determined by transaminases but does not translate to any significant clinical benefit in orthotopic liver transplant or liver resection.
Available clinical evidence does not support routine use of IPC in liver surgery as it does not offer any apparent benefit in perioperative outcome. Further clinical studies will need to be carried out to determine the subset of patients that will benefit from IPC.
缺血再灌注损伤是肝手术后并发症的主要原因。缺血预处理（IPC）已被证明可预防缺血再灌注损伤。临床研究已对肝手术中的IPC进行了检验，但结果相互矛盾。本系统评价旨在评估IPC对临床肝手术结局的影响。
对OVID Medline和Embase数据库进行电子检索，以识别报告接受IPC的肝手术患者结局的研究。使用基本描述性统计来汇总来自各个临床研究的数据。
共识别出1093篇文章，其中24篇符合纳入标准。选择了七个主题并进行亚组分析。尸体肝移植研究10项，活体亲属肝移植研究2项，肝切除研究12项。通过转氨酶测定，IPC可减少肝手术中的肝细胞损伤，但在原位肝移植或肝切除中未转化为任何显著的临床益处。
现有临床证据不支持在肝手术中常规使用IPC，因为它在围手术期结局方面未提供任何明显益处。需要进行进一步的临床研究以确定将从IPC中获益的患者亚组。
