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Jia Hong Dong - One of the best experts on this subject based on the ideXlab platform.
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preserving hepatic artery flow during Portal Triad blood occlusion improves regeneration of the remnant liver in rats with obstructive jaundice following partial hepatectomy
Experimental and Therapeutic Medicine, 2018Co-Authors: Zhe Kong, Chong Hui Li, Jian Jun Hu, Xin Lan Ge, Jia Hong DongAbstract:: In certain cases, major hepatectomy is essential and inevitable in patients with hilar cholangiocarcinoma and obstructive jaundice (OJ). The current study was designed to evaluate effects of a novel method of Portal blood occlusion, where the Portal vein was occluded (OPV) and the hepatic artery flow was preserved in rats with OJ that underwent partial hepatectomy. OJ was induced in rats by ligation of the common bile duct for 7 days. Subsequently, OJ rats underwent hepatectomy removing 76% of the liver following occlusion of the Portal Triad (OPT), OPV or without Portal blood occlusion. Liver blood flow (LBF), liver damage and regeneration were assessed. The safety limit for the duration of liver ischemia was 20 min for OPT and 40 min for OPV in rats with OJ. OPT and OPV methods resulted in significantly decreased microvascular LBF in rats with OJ from 529.53±91.55 laser speckle perfusion units (LSPU) in the control to 136.89±32.32 and 183.99±49.25 LSPU, respectively. Liver damage was assessed analyzing levels of serum alanine transaminase and direct bilirubin, determining interleukin-1β and tumor necrosis factor-α expression and histological examination. It was demonstrated that liver damage and caspase-3 and -9 expression in the liver were substantially reduced in the OPV group compared with the OPT group. In addition, the OPV method significantly improved liver regeneration in OJ rats, as indicated by increased rates of liver regeneration and expression of proliferating cell nuclear antigen and Ki-67 compared with the OPT group. Therefore, the OPV method may prolong the duration of Portal blood occlusion, reduce liver injury and improve liver regeneration by preserving hepatic arterial flow during Portal blood control in rats with OJ undergoing partial hepatectomy. The current study describes a novel technique, which may be applied in liver surgery in patients with complex jaundice.
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preserving hepatic artery flow during Portal Triad blood inflow occlusion reduces the outgrowth of hepatocarcinoma in mice after ischemia reperfusion
Hepatology Research, 2014Co-Authors: Chong Hui Li, Yong Wei Chen, Aiqun Zhang, Shizhong Yang, Jia Hong DongAbstract:Aim To investigate the effect of different hepatic vascular occlusion maneuvers on the growth of hepatocarcinoma after liver ischemia–reperfusion (I/R) injury. Methods A mice hepatocarcinoma model was established by Portal vein injection of H22 hepatoma cells. After 3 days, the mice underwent sham operation, occlusion of Portal Triad (OPT), Portal vein (OPV), or intermittent clamping (INT) operation. The hepatic I/R injury, pathological changes, hepatic replacement area, proliferative cell nuclear antigen expression, and extracellular signal-regulated kinase (ERK) 1/2 activation were assessed 5 days after reperfusion. Results Alanine aminotransferase and aspartate aminotransferase levels in the OPV group were significantly lower than those in the OPT and INT groups at 24 h after reperfusion. The hepatic injury of clamped liver lobes in the OPV group, represented by histopathological alterations and myeloperoxidase activity, was much slighter than that in the OPT and INT groups. The values of hepatic replacement area in the sham operation, OPT, OPV, and INT groups were 7.661 2.55%, 35.61 1 4.23%, 9.02 1 3.01%, and 19.95 1 4.10%, respectively. Proliferative cell nuclear antigen expression and ERK1/2 activation of tumor cells were the highest in the OPT group, and the lowest in the OPV and INT groups. Conclusion Preserving hepatic artery flow during Portal Triad blood inflow occlusion substantially inhibits the outgrowth of hepatocarcinoma via attenuating hepatic I/R injury in a murine liver tumor model. These results suggest a better prevention of hepatic tumor outgrowth after hepatectomy by using the selective Portal vein clamping method in liver cancer patients.
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preserving hepatic artery flow during Portal Triad blood inflow occlusion improves remnant liver regeneration in rats after partial hepatectomy
Journal of Surgical Research, 2013Co-Authors: Pengfei Wang, Yong Wei Chen, Chong Hui Li, Aiqun Zhang, Jia Hong DongAbstract:BACKGROUND: In the present study, we compared preservation of the hepatic artery flow during liver blood inflow occlusion with total Portal Triad blood flow clamping (the Pringle maneuver) to examine their effects on liver regeneration in rats after partial hepatectomy. MATERIALS AND METHODS: Male Wistar rats were randomized to a control group (without hepatic inflow occlusion), an occlusion of the Portal Triad (OPT) group (OPT for 30 min under Portal blood bypass), and an occlusion of the Portal vein (OPV) group (OPV only for 30 min under Portal blood bypass). All the rats underwent partial hepatectomy at the end of hepatic blood control. Liver regeneration was assessed on days 3 and 7 after hepatectomy. Liver damage, extracellular signal-regulated kinase-1/2 activation, and cytokine expression of the remnant liver in the first 24 h after hepatectomy were also assessed. RESULTS: Significantly greater liver regeneration, at a level similar to that of the control group, as indicated by the percentage of the initial liver weight, proliferating cell nuclear antigen and Ki-67 labeling indexes, and technetium-99m galactosyl human serum albumin liver uptake, was observed in the OPV group on day 3 after hepatectomy (P < 0.05 versus the OPT group). Liver damage, as represented by alanine aminotransferase and aspartate aminotransferase measurement and histopathologic examination, was substantially alleviated in the OPV group compared with the OPT group. In contrast to the control and OPV groups, the OPT group had markedly increased extracellular signal-regulated kinase-1/2 activation, heat shock protein 70, and interleukin-6 expression in response to ischemia and partial hepatectomy. CONCLUSIONS: Our results have indicated that compared with the Pringle maneuver, clamping the Portal vein while preserving the hepatic artery flow during partial hepatectomy is better for remnant liver regeneration at an early posthepatectomy stage.
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preserving hepatic artery flow during Portal Triad blood inflow occlusion reduces liver ischemia reperfusion injury in rats
Journal of Surgical Research, 2012Co-Authors: Yong Wei Chen, Chong Hui Li, Aiqun Zhang, Shizhong Yang, Wen Zhi Zhang, Jia Hong DongAbstract:Background Temporary Portal Triad clamping (Pringle maneuver) during liver resection can reduce intraoperative blood loss, but also correlates with liver ischemia and reperfusion (I/R) injury. The hepatic artery supplies 20%–30% blood but more than 50% O 2 to the liver. In this study, we explored if preservation of hepatic artery flow when performing Portal Triad blood inflow occlusion could reduce liver I/R injury while not increasing the blood loss. Materials and Methods Three groups of rats were created: group SO (sham operation), group OPT (occlusion of Portal Triad under Portal blood bypass), and group OPV (occlusion of Portal vein under Portal blood bypass). Blood flow was occluded for 90, 100, 110, and 120 min before reperfusion. Liver I/R injury was assessed by measuring the survival of rats within 7 d after operation, liver blood loss, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), liver tissue malondialdehyde (MDA), and Na + -K + -ATPase, and liver histology. Results The 7-d survival of rats in group OPV was higher than in group OPT. The safe tolerance limit was 90 min for group OPT and 110 min for group OPV. Liver blood loss in group OPT and OPV were significantly less than in group SO. However, no significant difference was observed in the amount of blood loss between group OPT and group OPV. The group OPV had significantly lower ALT, AST, and MDA values on the first hour and first day post-reperfusion than in group OPT. The Na + -K + -ATPase activity in OPV group was significantly higher than in group OPT 1 h post-reperfusion. Hepatocyte injury was significantly less in group OPV than in group OPT on histopathology. Conclusions These data indicate that continuously clamping the Portal vein while preserving the hepatic artery did not increase blood loss significantly in a rat liver I/R model, however this maneuver induced less liver I/R injury. It is therefore suggested that preserving hepatic artery inflow during Portal Triad blood inflow occlusion might become an alternative maneuver in liver surgery due to its ability to extend the safe tolerant time limit in normothermic hepatic ischemia.
Pierre-alain Clavien - One of the best experts on this subject based on the ideXlab platform.
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Clamping techniques and protecting strategies in liver surgery
Hpb, 2009Co-Authors: Mickael Lesurtel, Kuno Lehmann, Olivier De Rougemont, Pierre-alain ClavienAbstract:The use of vascular occlusion during liver resection is still a matter of debate. The aim of this review was to assess the advantages and disadvantages of Portal Triad occlusion as a protective strategy during elective liver resection and liver transplantation. Newer strategies such as pharmacological preconditioning are also discussed. A systematic literature search was conducted to detect randomized controlled trials assessing the effectiveness and safety of Portal Triad clamping, ischaemic preconditioning and pharmacological preconditioning during liver surgery. Vascular clamping cannot be systematically recommended. When used, Portal Triad clamping is associated with a tendency towards reduced blood loss and blood transfusion without having an impact on morbidity. Intermittent clamping appears to be better tolerated than continuous clamping, especially in patients with chronic liver disease. Ischaemic preconditioning before continuous Portal Triad clamping reduces reperfusion injury after warm ischaemia, particularly in steatotic patients. Ischaemic preconditioning has unclear effects in transplantation and there is currently no evidence to support or refute the use of ischaemic preconditioning in the donor. There are emerging alternative conditioning strategies, including the use of volatile anaesthetics, which may provide new and easily applicable therapeutic options to protect the liver.
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a prospective randomized controlled trial comparing intermittent Portal Triad clamping versus ischemic preconditioning with continuous clamping for major liver resection
Annals of Surgery, 2006Co-Authors: Henrik Petrowsky, Lucas Mccormack, Martha Trujillo, Markus Selzner, Wolfram Jochum, Pierre-alain ClavienAbstract:Liver resection has been increasingly performed over the last 2 decades worldwide due to improved postoperative outcomes and evidence that this approach offers the only curative option in many patients.1–3 Despite the success of liver surgery, excessive blood loss and the need for blood transfusion remain the most significant risk factors for poor outcome.2–4 Furthermore, the use of blood transfusion is associated with poorer long-term survival.4–6 Inflow occlusion by clamping of the Portal Triad (Pringle maneuver) has been used since the early 20th century to minimize blood loss during transection of the liver parenchyma,7–9 and became very popular during the 1980s.10 This strategy is particularly effective in preventing blood loss when associated with low central venous pressure (CVP).11,12 For example, we recently showed in a randomized controlled trial (RCT) that liver transection under inflow occlusion with the clamp crushing technique is associated with lower blood loss and reduced requirement for perioperative transfusions, than resection performed with more sophisticated transection devices claimed to enable safe surgery without the need for inflow occlusion.9 Currently, many surgeons worldwide use routine or selective inflow occlusion in patients undergoing major liver resection. A recent Japanese survey revealed that only the minority (7%) of surgeons never use inflow occlusion, whereas 25% apply a Pringle maneuver on a routine basis even in cirrhotic patients.13 However, the Pringle maneuver induces ischemic injury in the remnant liver, which is directly related to the duration of inflow occlusion and associated with increased morbidity and mortality.14 Ischemic preconditioning (IP) and intermittent clamping (IC) of the Portal Triad are the only clinically established protective strategies against liver injury due to prolonged ischemia.15 The protective effects of both strategies have been demonstrated in comparison with continuous inflow occlusion in several experimental studies16–21 and at the highest level of evidence in randomized clinical trials.22–24 On the other hand, a direct comparison between IP and IC in patients undergoing liver resection is currently not available. In a mouse model of warm ischemia, we found that both IC and IP were highly and equally protective against ischemic injury up to 75 minutes of hepatic ischemia with improved animal survival.18 However, IC proved superior for ischemic insults exceeding 75 minutes of duration. Therefore, in view of the established benefits of IC and IP in patients undergoing liver resection and the lack of clinical comparison between both approaches, we designed a RCT comparing both strategies in noncirrhotic patients undergoing major liver resection. Endpoints included the degree of reperfusion injury, intraoperative blood loss, transection time, and the incidence and severity of postoperative complications.
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optimal cycle of intermittent Portal Triad clamping during liver resection in the murine liver
Liver Transplantation, 2004Co-Authors: Koojeong Kang, Jae Hwi Jang, Yuna Kang, Kwan Kyu Park, Pierre-alain ClavienAbstract:We designed this experimental study to determine the optimal cycle for intermittent inflow occlusion during liver resection. A cycle of intermittent clamping (IC) for 15 minutes of ischemia followed by reperfusion for 5 minutes during liver resection is currently the most popular protocol used by experienced liver centers. As each period of reperfusion is associated with bleeding, longer periods of clamping would be advantageous. However, the longest safe duration of successive ischemia is unknown. Three groups of mice were subjected to a total liver ischemic period for 90 minutes; 2 groups underwent IC for 15 or 30 minutes, respectively, followed by 5 minutes of reperfusion, while the control group was subjected to continuous inflow occlusion only. The degree of tissue injury was assessed using biochemical and histological markers, as well as animal survival. While serious injury was observed in the continuous clamping group, both IC groups were associated with minimal injury, including lesser degrees of apoptosis and necrosis. All animals survived in the IC groups, while all animals died following 90 minutes of continuous inflow occlusion. In conclusion, intermittent Portal pedicle clamping with 15- or 30-minute cycles is highly protective. A period of 30 minutes clamping should be preferred, since this would decrease the amount of blood loss associated with each cycle. This data should be confirmed in humans, and may represent a change in the current practice of hepatic surgery. (Liver Transpl 2004;10:794–801.)
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protective effects of ischemic preconditioning for liver resection performed under inflow occlusion in humans
Annals of Surgery, 2000Co-Authors: Pierre-alain Clavien, Surinder S Yadav, David Sindram, Rex C BentleyAbstract:Clamping of the Portal Triad (inflow occlusion), also called the Pringle maneuver, is often used during liver surgery to minimize blood loss. Excessive blood loss during surgery and the need for transfusion have been shown to hinder the postoperative course. 1–3 Several recent clinical 4–6 and experimental 7,8 studies have demonstrated that intermittent clamping of the Portal Triad is better tolerated than prolonged continuous periods of ischemia. 5,6 However, the beneficial effect of intermittent clamping on ischemic injury, as assessed by postoperative serum transaminase and bilirubin levels, is counterbalanced by increased blood loss during the various reperfusion periods. If the protective mechanisms of intermittent ischemia could be identified, then innovative strategies could be developed to protect the liver against ischemic and reperfusion injury without increased blood loss. One strategy that could be applicable to hepatic surgery is ischemic preconditioning. Ischemic preconditioning is a short period of ischemia followed by a brief period of reperfusion before a sustained ischemic insult. Most of the data on ischemic preconditioning have been gathered in the heart, with a focus on the ability of preconditioning to reduce the size of a myocardial infarction. A few of the involved extracellular mediators, such as adenosine 9 and nitric oxide, 10 have been identified. Protection by ischemic preconditioning has been subsequently documented in a variety of tissues, including skeletal muscle, 11 brain, 12 spinal cord, 13 retina, 14 and intestine, 15 and is thought to be part of a ubiquitous protective mechanism against repetitive stress on cells and cell systems. Only a few investigators have studied the effects of ischemic preconditioning in the liver, 16–21 and only data in rodents are available. These studies have suggested that the liver could also be protected against ischemic insults by preconditioning. We recently identified an ischemic preconditioning protocol (10 minutes of ischemia followed by 15 minutes of reperfusion) that completely prevented animal death in mice subjected to 75 minutes of total hepatic ischemia, a lethal condition without preconditioning. 16 In view of our previous findings that apoptosis of sinusoidal endothelial cells and hepatocytes is a prominent feature of reperfusion injury in the warm ischemic liver, 22 we also studied the effects of ischemic preconditioning on postreperfusion apoptosis in a mouse model of partial hepatic ischemia. 16 Ischemic preconditioning was associated with complete abrogation of the massive hepatocellular apoptosis seen after prolonged periods of ischemia and downregulation of cytoplasmic caspase activities. Caspases are a family of cysteine proteases initiating complex proteolytic reactions leading to cell disassembly and death. 23 The beneficial effects of intermittent clamping of the Portal Triad, as reported by others, 4–8 might be related to a preconditioning effect. If so, a short period of ischemia may protect the liver during subsequent liver resection performed under inflow occlusion. This effect should occur without increased blood loss as seen during intermittent clamping. To test this hypothesis, we designed a study involving 24 patients undergoing major hepatectomy. To minimize variability, we adopted a rigid protocol including fixed periods of prolonged clamping after ischemic preconditioning, and a standardized technique of hepatectomy performed by a single surgeon (P.A.C.). We also attempted to identify underlying mechanisms of injury and protection from ischemic preconditioning in these patients.
Jerome M Laurence - One of the best experts on this subject based on the ideXlab platform.
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Portal Triad clamping versus other methods of vascular control in liver resection a systematic review and meta analysis
Hpb, 2012Co-Authors: Arthur Richardson, Jerome M LaurenceAbstract:Abstract Background Portal Triad clamping (PTC) is the most commonly used method of achieving vascular control during liver resection. However, the efficacy and safety of PTC, compared with those of other methods of vascular control, are uncertain. Methods A systematic review was conducted to identify randomized controlled trials (RCTs) comparing PTC with other methods of vascular control during liver resection. Endpoints included in-hospital mortality, need for transfusion, number of complications and length of hospital stay. Meta-analyses were performed using a random-effects model. Results Ten RCTs were identified; these included a total of 820 patients. No statistically significant differences between PTC and other forms of vascular control in liver resection were demonstrated. Conclusions There is no evidence, on the basis of this meta-analysis of RCTs, of any difference between PTC and other forms of vascular control in liver resection.
Jurgen Weitz - One of the best experts on this subject based on the ideXlab platform.
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Portal Triad clamping versus vascular exclusion for vascular control during hepatic resection a systematic review and meta analysis
Journal of Gastrointestinal Surgery, 2009Co-Authors: Nuh N Rahbari, Moritz Koch, Arianeb Mehrabi, Kathrin Weidmann, Edith Motschall, Christoph Kahlert, Markus W Buchler, Jurgen WeitzAbstract:Objective To compare the clinical outcome of patients undergoing liver resection under Portal Triad clamping (PTC) versus hepatic vascular exclusion (HVE).
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systematic review and meta analysis of the effect of Portal Triad clamping on outcome after hepatic resection
British Journal of Surgery, 2008Co-Authors: Nuh N Rahbari, Edith Motschall, Jurgen Weitz, Moritz N Wente, Peter Schemmer, Markus K Diener, Katrin Hoffmann, Jan Schmidt, Markus W BuchlerAbstract:BACKGROUND: The effect of Portal Triad clamping (PTC) on outcome after hepatic resection is uncertain. METHODS: A systematic literature search was conducted to detect randomized controlled trials (RCTs) assessing the effectiveness and safety of PTC alone and of PTC with ischaemic preconditioning (IPC) of the liver. Studies on clamping of the inferior vena cava or hepatic veins were excluded. Endpoints included postoperative overall morbidity and mortality, cardiopulmonary and hepatic morbidity, blood loss, transfusion rates and alanine aminotransferase (ALT) levels. Meta-analyses were performed using a random-effects model. RESULTS: Eight RCTs published between 1997 and 2006 containing a total of 558 patients were eligible for final analysis. The design of the identified studies varied considerably. Analyses of endpoints revealed no difference between intermittent PTC and no PTC. Meta-analyses of PTC with and without previous IPC revealed no differences, but postoperative ALT levels were significantly lower with IPC. CONCLUSION: On currently available evidence, the routine use of PTC does not offer any benefit in perioperative outcome after liver resection. It cannot be recommended as a standard procedure.
Yong Wei Chen - One of the best experts on this subject based on the ideXlab platform.
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preserving hepatic artery flow during Portal Triad blood inflow occlusion reduces the outgrowth of hepatocarcinoma in mice after ischemia reperfusion
Hepatology Research, 2014Co-Authors: Chong Hui Li, Yong Wei Chen, Aiqun Zhang, Shizhong Yang, Jia Hong DongAbstract:Aim To investigate the effect of different hepatic vascular occlusion maneuvers on the growth of hepatocarcinoma after liver ischemia–reperfusion (I/R) injury. Methods A mice hepatocarcinoma model was established by Portal vein injection of H22 hepatoma cells. After 3 days, the mice underwent sham operation, occlusion of Portal Triad (OPT), Portal vein (OPV), or intermittent clamping (INT) operation. The hepatic I/R injury, pathological changes, hepatic replacement area, proliferative cell nuclear antigen expression, and extracellular signal-regulated kinase (ERK) 1/2 activation were assessed 5 days after reperfusion. Results Alanine aminotransferase and aspartate aminotransferase levels in the OPV group were significantly lower than those in the OPT and INT groups at 24 h after reperfusion. The hepatic injury of clamped liver lobes in the OPV group, represented by histopathological alterations and myeloperoxidase activity, was much slighter than that in the OPT and INT groups. The values of hepatic replacement area in the sham operation, OPT, OPV, and INT groups were 7.661 2.55%, 35.61 1 4.23%, 9.02 1 3.01%, and 19.95 1 4.10%, respectively. Proliferative cell nuclear antigen expression and ERK1/2 activation of tumor cells were the highest in the OPT group, and the lowest in the OPV and INT groups. Conclusion Preserving hepatic artery flow during Portal Triad blood inflow occlusion substantially inhibits the outgrowth of hepatocarcinoma via attenuating hepatic I/R injury in a murine liver tumor model. These results suggest a better prevention of hepatic tumor outgrowth after hepatectomy by using the selective Portal vein clamping method in liver cancer patients.
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preserving hepatic artery flow during Portal Triad blood inflow occlusion improves remnant liver regeneration in rats after partial hepatectomy
Journal of Surgical Research, 2013Co-Authors: Pengfei Wang, Yong Wei Chen, Chong Hui Li, Aiqun Zhang, Jia Hong DongAbstract:BACKGROUND: In the present study, we compared preservation of the hepatic artery flow during liver blood inflow occlusion with total Portal Triad blood flow clamping (the Pringle maneuver) to examine their effects on liver regeneration in rats after partial hepatectomy. MATERIALS AND METHODS: Male Wistar rats were randomized to a control group (without hepatic inflow occlusion), an occlusion of the Portal Triad (OPT) group (OPT for 30 min under Portal blood bypass), and an occlusion of the Portal vein (OPV) group (OPV only for 30 min under Portal blood bypass). All the rats underwent partial hepatectomy at the end of hepatic blood control. Liver regeneration was assessed on days 3 and 7 after hepatectomy. Liver damage, extracellular signal-regulated kinase-1/2 activation, and cytokine expression of the remnant liver in the first 24 h after hepatectomy were also assessed. RESULTS: Significantly greater liver regeneration, at a level similar to that of the control group, as indicated by the percentage of the initial liver weight, proliferating cell nuclear antigen and Ki-67 labeling indexes, and technetium-99m galactosyl human serum albumin liver uptake, was observed in the OPV group on day 3 after hepatectomy (P < 0.05 versus the OPT group). Liver damage, as represented by alanine aminotransferase and aspartate aminotransferase measurement and histopathologic examination, was substantially alleviated in the OPV group compared with the OPT group. In contrast to the control and OPV groups, the OPT group had markedly increased extracellular signal-regulated kinase-1/2 activation, heat shock protein 70, and interleukin-6 expression in response to ischemia and partial hepatectomy. CONCLUSIONS: Our results have indicated that compared with the Pringle maneuver, clamping the Portal vein while preserving the hepatic artery flow during partial hepatectomy is better for remnant liver regeneration at an early posthepatectomy stage.
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preserving hepatic artery flow during Portal Triad blood inflow occlusion reduces liver ischemia reperfusion injury in rats
Journal of Surgical Research, 2012Co-Authors: Yong Wei Chen, Chong Hui Li, Aiqun Zhang, Shizhong Yang, Wen Zhi Zhang, Jia Hong DongAbstract:Background Temporary Portal Triad clamping (Pringle maneuver) during liver resection can reduce intraoperative blood loss, but also correlates with liver ischemia and reperfusion (I/R) injury. The hepatic artery supplies 20%–30% blood but more than 50% O 2 to the liver. In this study, we explored if preservation of hepatic artery flow when performing Portal Triad blood inflow occlusion could reduce liver I/R injury while not increasing the blood loss. Materials and Methods Three groups of rats were created: group SO (sham operation), group OPT (occlusion of Portal Triad under Portal blood bypass), and group OPV (occlusion of Portal vein under Portal blood bypass). Blood flow was occluded for 90, 100, 110, and 120 min before reperfusion. Liver I/R injury was assessed by measuring the survival of rats within 7 d after operation, liver blood loss, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), liver tissue malondialdehyde (MDA), and Na + -K + -ATPase, and liver histology. Results The 7-d survival of rats in group OPV was higher than in group OPT. The safe tolerance limit was 90 min for group OPT and 110 min for group OPV. Liver blood loss in group OPT and OPV were significantly less than in group SO. However, no significant difference was observed in the amount of blood loss between group OPT and group OPV. The group OPV had significantly lower ALT, AST, and MDA values on the first hour and first day post-reperfusion than in group OPT. The Na + -K + -ATPase activity in OPV group was significantly higher than in group OPT 1 h post-reperfusion. Hepatocyte injury was significantly less in group OPV than in group OPT on histopathology. Conclusions These data indicate that continuously clamping the Portal vein while preserving the hepatic artery did not increase blood loss significantly in a rat liver I/R model, however this maneuver induced less liver I/R injury. It is therefore suggested that preserving hepatic artery inflow during Portal Triad blood inflow occlusion might become an alternative maneuver in liver surgery due to its ability to extend the safe tolerant time limit in normothermic hepatic ischemia.