[Influence of the Pringle's maneuver time applied in children during hepatic tumors resections on the postoperative course of treatment].
One of the ways of diminishing risk of massive blood loss during liver surgery is the temporal vascular exclusion of the liver/Pringle maneuver. Scanty publications on the problem of liver resections in children are based on very limited series of patients and did not define save periods of time of temporal vascular exclusion of the liver during operation in this group of patients. They also did not specify the effects arising from prolonged acute hepatocytes ischemia in children. The aim of the study was the assessment of the influence of length of time of Pringle maneuver on the liver cells function in the perioperative period and the assessment of its influence on the postoperative course of treatment.


METHODS
Patients according to the duration of Pringle maneuver were divided into 2 groups. Group I consisted of 18 patients, in whom the duration of Pringle maneuver was below 32 minutes. Group II consisted of 17 patients, in whom the duration of Pringle maneuver was between 32 and 60 minutes. Selection of the periods of duration of Pringle maneuver was dictated by mean and mediana value of its lasting. In patients from both groups values of the level of AspAT, ALAT LDH and INR were assessed in postoperative day 1, 2 and 3 as well as time of mechanical ventilation, length of stay in ICU, and the duration of hospitalization.


RESULTS
In group II of children operated with Pringle maneuver lasted between 32 and 60 minutes, statistically significant longer mean value of time of operation was indicated, as well as statistically significant higher mean value of biochemical parameters describing liver cells function, slow down dynamic of normalization of INR in the first 3 postoperative days and statistically significant higher mean value of length of time of hospitalization.


CONCLUSIONS
Extension of time of Pringle maneuver in children from 30 to 60 minutes may be connected with transient postoperative biochemical dysfunction of hepatocytes characterized by slow down dynamic of normalization of the level of liver enzymes as well as may results in extension of time of hospitalization connected with necessity of normalization of transient postoperative biochemical dysfunction of hepatocytes.
Kaźmirczuk
Roman
R
Uniwersytet Mikołaja Kopernika w Toruniu, Collegium Medicum w Bydgoszczy, Katedra i Klinika Anestezjologii i Intensywnej Terapii. kazmirczuk@wp.pl
Kusza
Krzysztof
K
Prokurat
Andrzej
A
Chrupek
Małgorzata
M
D014408:Biomarkers, Tumor / Q000097:blood*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D022781:Hepatocytes / Q000201:enzymology*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000098:blood supply; D008113:Liver Neoplasms / Q000201:enzymology* / Q000601:surgery*; D008297:Male; D011184:Postoperative Period; D012121:Respiration, Artificial / Q000706:statistics & numerical data
D014408:Biomarkers, Tumor