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Hepatic resection under in situ hypothermic hepatic perfusion
Takashi Kaiho1, Toshikazu Tanaka, Shunichi Tsuchiya
1Department of Surgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu City, Chiba, Japan 292-8535. tkaiho@ipi.mm-m.ne.jp
Hepato-Gastroenterology
|June 28, 2003
Summary
In situ hypothermic perfusion is a safer method for liver resection than Pringle's maneuver, reducing blood loss and improving liver function recovery in patients with liver disease.
Area of Science:
- Hepatobiliary surgery
- Surgical innovation
- Liver transplantation
Background:
- Pringle's maneuver is standard for reducing bleeding during hepatectomy.
- However, it can cause significant ischemic-reperfusion injury, especially in patients with compromised liver function.
Purpose of the Study:
- To evaluate the efficacy and safety of in situ hypothermic perfusion compared to intermittent Pringle's maneuver during hepatectomy.
- To assess the impact of these techniques on liver function and recovery.
Main Methods:
- A comparative study involving 37 patients undergoing hepatic resections.
- Patients were divided into two groups: intermittent Pringle's maneuver (IP group, n=17) and in situ hypothermic perfusion (CP group, n=20).
- The CP group received continuous cold (4°C) Ringer's lactate perfusion during resection.
Main Results:
- The cold perfusion technique significantly reduced operative time and blood loss (p < 0.05).
- Serum hyaluronic acid levels were significantly lower in the CP group post-reperfusion (p < 0.05).
- Hepaplastin levels were significantly higher in the CP group one week post-operation (p < 0.05).
Conclusions:
- In situ hypothermic perfusion allows for safe prolongation of ischemic time during hepatectomy with minimal systemic effects.
- This technique may offer advantages over intermittent Pringle's maneuver in minimizing hepatic sinusoidal endothelial cell damage and improving post-operative liver function, particularly in patients with underlying liver disease.