Horiuchi T, Muraoka R, Tabo T, Uchinami M, Kimura N, Tanigawa N
Second Department of Surgery, Fukui Medical School, Japan.
Arch Surg. 1995 Jul;130(7):754-8. doi: 10.1001/archsurg.1995.01430070076015.
To evaluate the intermittent clamping of hepatic vessels during liver surgery and to determine the optimal duration of ischemia and reperfusion.
One hundred nine adult male Sprague-Dawley rats.
Partial (70%) ischemia of the rat liver was induced by clamping of the left pedicle. To assess the influence of a single period of ischemia, the rats were divided into three groups for 15, 20, or 30 minutes of ischemia. To evaluate the influence of reperfusion duration, reperfusion following 15-minute ischemia was repeated 10 times in three groups for 5, 10, or 15 minutes of reperfusion duration. Hepatic tissue blood flow (HTBF) and hepatic beta-adenosine triphosphate (beta-ATP) levels were measured serially, and histopathological specimens were studied following single episodes of ischemia. In the reperfusion experiments, hepatic enzyme levels, survival rates, HTBF, beta-ATP, and histopathological findings were analyzed.
When the single period of ischemia was 15 minutes, HTBF and beta-ATP levels recovered after 1 hour of reperfusion. However, both HTBF and beta-ATP levels did not return to preischemic levels when the duration of the ischemia was 20 or 30 minutes. Levels of beta-ATP and HTBF were higher, with improvement in both the histopathological findings and the survival rate, when the duration of the repeated reperfusion periods was 15 minutes, compared with 5 or 10 minutes.
The maximum period of ischemia without irreversible damage was 15 minutes in rat liver. The damage was less severe when the duration of the repeated reperfusion periods was 15 minutes rather than 5 or 10 minutes.
评估肝脏手术期间肝血管的间歇性阻断，并确定缺血和再灌注的最佳时长。
109只成年雄性斯普拉格-道利大鼠。
通过夹闭左肝蒂诱导大鼠肝脏70%的部分缺血。为评估单次缺血的影响，将大鼠分为三组，分别进行15、20或30分钟的缺血处理。为评估再灌注时长的影响，三组大鼠在15分钟缺血后进行再灌注，再灌注时长分别为5、10或15分钟，重复10次。连续测量肝组织血流量（HTBF）和肝β-三磷酸腺苷（β-ATP）水平，并在单次缺血后研究组织病理学标本。在再灌注实验中，分析肝酶水平、生存率、HTBF、β-ATP和组织病理学结果。
当单次缺血时长为15分钟时，再灌注1小时后HTBF和β-ATP水平恢复。然而，当缺血时长为20或30分钟时，HTBF和β-ATP水平均未恢复到缺血前水平。与5或10分钟相比，当重复再灌注时长为15分钟时，β-ATP和HTBF水平更高，组织病理学结果和生存率均有所改善。
大鼠肝脏无不可逆损伤的最长缺血时长为15分钟。当重复再灌注时长为15分钟而非5或10分钟时，损伤较轻。
