Kolahdoozan Mohsen, Behdad Akbar, Hosseinpour Mehrdad, Behdad Samin, Rezaei Mohammad Taghi
Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran.
Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran.
Arch Trauma Res. 2015 Nov 23;4(4):e30244. doi: 10.5812/atr.30244. eCollection 2015 Dec.
The liver is the most commonly injured organ in blunt abdominal trauma. Although major hepatic bleeding may be partially controlled with portal triade clamping (the Pringle's maneuver), continuous prolonged clamping results in liver ischemia.
The purpose of this study was to determine the safe time of Pringle maneuver based on pathologic changes of liver in rabbit models.
In an experimental study, 20 New-Zealand white rabbits were selected. In laparotomy, a blunt dissector was passed through the foramen of Winslow and the hepato-duodenal ligament encircled with an umbilical tape. En masse Pringle maneuver was performed using atraumatic flexible clamps. Rabbits were divided into four groups based on Pringle maneuver time (30 minutes, 45 minutes, 60 minutes, and 75 minutes). A hepatic biopsy was performed at the beginning of operation. The degree of tissue injury was evaluated using blood markers.
There were five rabbits in each group. At the end of 60 minutes ischemia, only minor alterations were observed in pathological specimens. At the end of 75 minutes, hepatocyte damage and necrosis were observed. The serum levels of alanine aminotransferase (Group A: P = 0.02; Group B: P = 0.01; Group C: P = 0.0002; Group D: P = 0.01) and Aspartate aminotransferase (Group A: P = 0.03; Group B: P = 0.002; Group C: P = 0.0004; Group D: P = 0.0003) were significantly increased post-operatively. The maximum level was in the first day after operation.
Continuous portal triade clamping (the Pringle maneuver) during liver ischemia (30 and 45 minutes) in rabbits resulted in no ischemic change. Increasing time of clamping to 30 minutes was safe in intermittent Pringle maneuver.
肝脏是钝性腹部创伤中最常受损的器官。尽管主要肝出血可通过门静脉三联钳夹术（普林格尔手法）得到部分控制，但持续长时间钳夹会导致肝脏缺血。
本研究旨在基于兔模型肝脏的病理变化确定普林格尔手法的安全时间。
在一项实验研究中，选取20只新西兰白兔。在剖腹手术中，用钝性剥离器经网膜孔穿过，并用脐带胶带环绕肝十二指肠韧带。使用无创伤柔性夹进行整块普林格尔手法操作。根据普林格尔手法操作时间（30分钟、45分钟、60分钟和75分钟）将兔子分为四组。在手术开始时进行肝脏活检。使用血液标志物评估组织损伤程度。
每组有5只兔子。缺血60分钟结束时，病理标本仅观察到轻微改变。75分钟结束时，观察到肝细胞损伤和坏死。术后血清丙氨酸氨基转移酶水平（A组：P = 0.02；B组：P = 0.01；C组：P = 0.0002；D组：P = 0.01）和天冬氨酸氨基转移酶水平（A组：P = 0.03；B组：P = 0.002；C组：P = 0.0004；D组：P = 0.0003）显著升高。最高水平出现在术后第一天。
兔肝脏缺血期间（30分钟和45分钟）持续门静脉三联钳夹术（普林格尔手法）未导致缺血改变。在间歇性普林格尔手法中，将钳夹时间延长至30分钟是安全的。
