Hepatic resection under in situ hypothermic hepatic perfusion.
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.
Kaiho
Takashi
T
Department of Surgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu City, Chiba, Japan 292-8535. tkaiho@ipi.mm-m.ne.jp
Tanaka
Toshikazu
T
Tsuchiya
Shunichi
S
Yanagisawa
Shinji
S
Takeuchi
Osamu
O
Miura
Masami
M
Saigusa
Naoki
N
Kitakata
Yusuke
Y
Miyazaki
Masaru
M
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