A safe protocol of intermittent hilar vascular clamping for hepatic resection in cirrhosis.
OBJECTIVE
In liver surgery, vascular clamping reduces blood loss but may induce ischemia-reperfusion injury. However, the best protocol of hepatic vascular occlusion remains controversial. Recently, we reported safe clamping associated with least ischemia-reperfusion injury as assessed by calpain-p in a rat model. In this study, it was applied the same protocol during resection of hepatocellular carcinoma in patients with liver cirrhosis. METHODODOGY: Patients were divided into four groups; group 1: repeated 10-min complete clamping of the hepatic vasculature with 5-min reperfusion (n=62), group 2: similar to group 1 but complete clamping for more than 10-min (n=18), group 3: similar to group 1 but hemi-hepatic occlusion only (n=20), and Group 4: similar to group 3 but hemi-hepatic for more than 10-min (n=46). Postoperative liver function was assessed at days 1, 3 and 5.


RESULTS
There were no differences in PT and T. Bil among the groups; AST on postoperative day 5 was lower in Group 1 than in Group 2 (p < 0.001). Western blot analysis and immunohistochemistry confirmed upregulation of calpain-mu induced by hepatic vascular clamping.


CONCLUSIONS
Our results indicated that repeated 10-min hepatic vascular clamping interrupted by 5-min reperfusion is a safe protocol as it does not cause ischemia-reperfusion injury.
Nagano
Hiroaki
H
Department of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita 565-0871 Osaka, Japan. hnagano@gesurg.med.osaka-u.ac.jp
Kishimoto
Shinichi
S
Kobayashi
Shogo
S
Marubashi
Shigeru
S
Eguchi
Hidetoshi
H
Takeda
Yutaka
Y
Tanemura
Masahiro
M
Tomimaru
Yoshito
Y
Noda
Takehiro
T
Umeshita
Koji
K
Sakon
Masato
M
Doki
Yuichiro
Y
Mori
Masaki
M
Monden
Morito
M
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D015153:Blotting, Western; D002154:Calpain / Q000097:blood; D004792:Enzyme Precursors / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D008099:Liver / Q000098:blood supply*; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015427:Reperfusion Injury / Q000517:prevention & control
D004792:Enzyme Precursors; D000410:Alanine Transaminase; D002154:Calpain; C047018:procalpain