[The effect of porto-intrahepatic portal bypass on the ischemic liver during clamping the hepatic inflow].
The object of this study was to determine the critical bypass flow rate of the porto-intrahepatic portal bypass during clamping the hepatic inflow, and to clarify the pathophysiology caused by this bypass procedure with special emphasis on the hepatic injury. Porto-intrahepatic portal bypass was instituted, using anti-thrombogenic catheter (Anthron), during clamping the hepatic inflow in anesthetized dogs. Bypass flow rate (BFR) was controlled at 10%, 30% and 60% of the portal flow in the individual experimental groups. As the control study, double bypass (portosystemic and femoral arterio-intrahepatic portal bypass) or portal-systemic bypass was instituted during clamping the hepatic inflow, and porto-systemic bypass at 10% and 60% during clamping the portal vein. Total adenine nucleotide (TAN) and adenylate energy charge (EC) of the liver did not change during 2 hour clamp of the portal vein. Clamping the hepatic inflow, unless congested splanchnic circulation, demonstrated the same level as 30% porto-portal bypass. Taking changes in hemodynamics, portal into consideration and arterial pH and PO2 levels, serum transaminase levels, ICG retention rate and animal survival rate, we conclude that insufficient flow rate of porto-portal bypass (10%, 30%) even cause more severe hepatic damage, and critical flow rate must be between 30% and 60% during 1 hour clamp.
Fukumoto
T
T
Department of Surgery, Jichi Medical School, Tochigi, Japan.
D000227:Adenine Nucleotides / Q000378:metabolism; D000818:Animals; D003250:Constriction; D004285:Dogs; D004734:Energy Metabolism; D006863:Hydrogen-Ion Concentration; D007511:Ischemia / Q000097:blood / Q000378:metabolism / Q000503:physiopathology*; D008099:Liver / Q000098:blood supply* / Q000378:metabolism; D008102:Liver Circulation; D010100:Oxygen / Q000097:blood; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical
D000227:Adenine Nucleotides; D010100:Oxygen