Experimental study of the protective effect of intermittent hepatic pedicle clamping in the rat.
The tolerance of the liver to ischaemia during intermittent clamping of the hepatic pedicle was compared with that during a continuous Pringle manoeuvre. Three groups of rats undergoing total durations of clamping of 60, 90 and 120 min were studied. A temporary peroperative portacaval shunt was used to exclude the effects of splanchnic venous stasis and allow independent study of the effects of hepatic ischaemia. In each group, three methods of portal clamping were evaluated: a continuous Pringle manoeuvre (n = 10), a 30-min intermittent clamping (n = 10) and a 15-min intermittent clamping (n = 10). The clamp release time between the periods of liver ischaemia was 5 min. Survival at day 7 and postoperative changes in liver function (transaminase enzymes, bilirubin, bromsulphthalein elimination, liver adenosine 5'-triphosphate levels) were recorded. Intermittent clamping of the pedicle was tolerated significantly better than continuous clamping. This method optimizes the ability of the liver to tolerate extended periods of ischaemia. For a given duration of ischaemia, no additional improvement could be produced by shortening the intermittent clamping period from 30 to 15 min. These data suggest that, when the Pringle manoeuvre is used, it should be applied intermittently rather than continuously.
Isozaki
H
H
Hepatobiliary Surgery and Liver Transplant Research Unit, South Paris Faculty of Medicine, Paul Brousse Hospital, Villejuif, France.
Adam
R
R
Gigou
M
M
Szekely
A M
AM
Shen
M
M
Bismuth
H
H
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003250:Constriction; D006470:Hemorrhage / Q000517:prevention & control*; D007511:Ischemia / Q000517:prevention & control; D008099:Liver / Q000098:blood supply / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D011167:Portacaval Shunt, Surgical; D051381:Rats; D011919:Rats, Inbred Strains; D013997:Time Factors