Intermittent hepatic pedicle clamping reduces liver and lung injury.
BACKGROUND
Temporary occlusion of the hepatic hilum is used to control hemorrhage during liver resection, but can result in widespread organ dysfunction.


METHODS
Adult male Sprague-Dawley rats were subjected to either continuous (Group C) or intermittent (Group R) hepatic ischemia. The total ischemia time (60 min) was divided into four 15-min periods in Group R. Blood and lung tissue specimens were collected 2 h after the induction of ischemia (early phase), and 24 h after the termination of ischemia (late phase). Plasma lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) concentrations were measured. Histologic sections were studied using hematoxylin and eosin, as well as naphthol AS-D chloroacetate esterase techniques.


RESULTS
In the early phase, LDH, ALT, TNF-alpha, and IL-6 concentrations were significantly higher in Group C than in Group R. Pulmonary septal thickening and polymorphonuclear leukocyte infiltration were less severe in Group R than in Group C. These differences were significant in the late phase.


CONCLUSIONS
Intermittent hepatic pedicle clamping reduces the ischemia-reperfusion injury not only to the liver but also to the lungs. This technique may improve the outcome in patients undergoing liver resection.
Kimura
N
N
Second Department of Surgery, Fukui Medical University, Fukui, Matsuoka, 910-11, Japan.
Muraoka
R
R
Horiuchi
T
T
Tabo
T
T
Uchinami
M
M
Yokomachi
J
J
Doi
K
K
D000410:Alanine Transaminase / Q000378:metabolism; D000818:Animals; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001784:Blood Gas Analysis; D001794:Blood Pressure; D015850:Interleukin-6 / Q000097:blood; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008026:Ligation; D008099:Liver / Q000098:blood supply* / Q000201:enzymology / Q000601:surgery; D008107:Liver Diseases / Q000378:metabolism / Q000601:surgery*; D008297:Male; D009504:Neutrophils / Q000166:cytology; D011650:Pulmonary Alveoli / Q000098:blood supply* / Q000473:pathology; D011654:Pulmonary Edema / Q000378:metabolism* / Q000473:pathology; D051381:Rats; D017207:Rats, Sprague-Dawley; D015427:Reperfusion Injury / Q000378:metabolism*; D013525:Surgical Instruments; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase