title: Hepatic resection under in situ hypothermic hepatic perfusion.
abstract: OBJECTIVE
  Temporary inflow occlusion of the portal triad has been used frequently in hepatectomy to minimize bleeding. On the other hand, Pringle's maneuver produces ischemic-reperfusion injury especially in patients with underlying liver disease.
  
  
  METHODS
  Thirty-seven cases of hepatic resections were performed with intermittent Pringle's maneuver (IP group; n = 17) and in situ hypothermic perfusion (CP group; n = 20). In the CP group, hepatic inflow was continuously occluded, and 4-degree Centigrade Ringer's lactate was administered by drip during resection. Hepatic outflow occlusion was not performed.
  
  
  RESULTS
  All patients tolerated the procedures well. Cold perfusion technique significantly decreased both the times required and the blood loss in hepatectomy (p < 0.05). Serum hyaluronic acid levels gradually increased after the induction of hepatectomy and peaked 10 minutes after reperfusion in the both groups. Thereafter, it decreased and showed a significantly lower level in the CP group until 60 minutes after reperfusion (p < 0.05). Hepaplastin levels remained significantly higher in the CP group one week after operation (p < 0.05).
  
  
  CONCLUSIONS
  Using the technique of in situ hypothermic perfusion, we can prolong the ischemic time safely with minimal systemic influence even in cases with underlying liver diseases. This may compare favorably with intermittent Pringle's maneuver in terms of reducing hepatic sinusoidal endothelial cell damage during hepatectomy and reperfusion.
authors.affiliation: Department of Surgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu City, Chiba, Japan 292-8535. tkaiho@ipi.mm-m.ne.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Kaiho
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Shunichi
authors.initials: S
authors.lastname: Tsuchiya
authors.forename: Shinji
authors.initials: S
authors.lastname: Yanagisawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Takeuchi
authors.forename: Masami
authors.initials: M
authors.lastname: Miura
authors.forename: Naoki
authors.initials: N
authors.lastname: Saigusa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kitakata
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000503:physiopathology; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery*; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D005706:Gallbladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007511:Ischemia / Q000503:physiopathology*; D008099:Liver / Q000098:blood supply*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000503:physiopathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010477:Perfusion; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control; D012189:Retrospective Studies