血管流入阻断（普林格尔手法）期间肝微血管血流的患者间异质性。

Interpatient heterogeneity in hepatic microvascular blood flow during vascular inflow occlusion (Pringle manoeuvre).

作者信息

Shen Lucinda, Uz Zühre, Verheij Joanne, Veelo Denise P, Ince Yasin, Ince Can, van Gulik Thomas M

机构信息

Department of Translational Physiology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

出版信息

Hepatobiliary Surg Nutr. 2020 Jun;9(3):271-283. doi: 10.21037/hbsn.2020.02.04.

DOI:10.21037/hbsn.2020.02.04

PMID:32509813

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7262621/

Abstract

BACKGROUND

Vascular inflow occlusion (VIO) during liver resections (Pringle manoeuvre) can be applied to reduce blood loss, however may at the same time, give rise to ischemia-reperfusion injury (IRI). The aim of this study was to assess the characteristics of hepatic microvascular perfusion during VIO in patients undergoing major liver resection.

METHODS

Assessment of hepatic microcirculation was performed using a handheld vital microscope (HVM) at the beginning of surgery, end of VIO (20 minutes) and during reperfusion after the termination of VIO. The microcirculatory parameters assessed were: functional capillary density (FCD), microvascular flow index (MFI) and sinusoidal diameter (SinD).

RESULTS

A total of 15 patients underwent VIO; 8 patients showed hepatic microvascular perfusion despite VIO (partial responders) and 7 patients showed complete cessation of hepatic microvascular perfusion (full responders). Functional microvascular parameters and blood flow levels were significantly higher in the partial responders when compared to the full responders during VIO (FCD: 0.84±0.88 . 0.00±0.00 mm/mm, P<0.03, respectively, and MFI: 0.69-0.22 . 0.00±0.00, P<0.01, respectively).

CONCLUSIONS

An interpatient heterogeneous response in hepatic microvascular blood flow was observed upon VIO. This may explain why clinical strategies to protect the liver against IRI lacked consistency.

摘要

背景

肝切除术中的血管流入阻断（VIO，普林格尔手法）可用于减少失血，但同时可能会引发缺血再灌注损伤（IRI）。本研究的目的是评估接受大肝切除术患者在VIO期间肝微血管灌注的特征。

方法

在手术开始时、VIO结束时（20分钟）以及VIO终止后的再灌注期间，使用手持式活体显微镜（HVM）评估肝微循环。评估的微循环参数包括：功能性毛细血管密度（FCD）、微血管血流指数（MFI）和肝血窦直径（SinD）。

结果

共有15例患者接受了VIO；8例患者尽管进行了VIO仍显示肝微血管灌注（部分反应者），7例患者显示肝微血管灌注完全停止（完全反应者）。在VIO期间，部分反应者的功能性微血管参数和血流水平显著高于完全反应者（FCD：分别为0.84±0.88对0.00±0.00mm/mm，P<0.03；MFI：分别为0.69对0.22对0.00±0.00，P<0.01）。