活体肝移植术中应用Pringle手法对供体和受体缺血再灌注损伤的影响。

The Effect of Pringle Maneuver Applied during Living Donor Hepatectomy on the Ischemia-Reperfusion Injury Observed in the Donors and Recipients.

作者信息

Dalda Yasin, Akbulut Sami, Sahin Tevfik Tolga, Tuncer Adem, Ogut Zeki, Satilmis Basri, Dalda Ozlem, Gul Mehmet, Yilmaz Sezai

机构信息

Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.

Department of Biochemistry, Inonu University Faculty of Pharmacy, 44280 Malatya, Turkey.

出版信息

Medicina (Kaunas). 2024 Apr 18;60(4):649. doi: 10.3390/medicina60040649.

Abstract

: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. : A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied ( = 27) and Pringle maneuver not applied ( = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed ( = 27) and not performed ( = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-α, and β-galactosidase measurements, and histopathological findings were examined. : There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications ( = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group ( = 0.001). : Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses.

摘要

本研究的目的是评估采用或未采用Pringle手法的供体残余肝脏缺血再灌注损伤的临床和实验室变化。此外,我们评估了接受这些供体肝脏移植的受者。

共有108例患者(54例活体肝供体和54例肝受者)纳入了2021年2月至2021年6月期间的这项随机双盲研究,其中包括接受供体肝切除术的供体以及接受活体供肝移植的受者。将供体分为两组:应用Pringle手法组(n = 27)和未应用Pringle手法组(n = 27)。同样,接受来自这些供体植入肝脏的受者也根据是否进行Pringle手法分为两组(n = 27)和(n = 27)。在术前、术后0小时(手术日)、术后第1天、术后第2天、术后第3天、术后第4天、术后第5天采集供体和受者的血样,并在后台操作期间从移植物中获取肝组织。检查肝功能测试、全血细胞计数、凝血测试、IL-1、IL-2、IL-6、TNF-α和β-半乳糖苷酶测量值以及组织病理学结果。

在应用和未应用Pringle手法的供体中,所有时期缺血再灌注损伤的生化分析参数均无统计学显著差异。同样,接受应用和未应用Pringle手法获取的肝脏移植的受者之间也无统计学显著差异。两组受者在围手术期出血和早期胆管并发症方面无统计学显著差异(P = 0.685)。在组织病理学检查中,Pringle手法组的肝细胞损伤明显更高(P = 0.001)。

尽管发现Pringle手法组的肝细胞损伤组织学评分更高,但通过临床和实验室分析评估,Pringle手法并未加重供体和受者的缺血再灌注损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4152/11051728/a7ae6ad39f4d/medicina-60-00649-g001.jpg

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