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Updated: Jun 18, 2026
Method of Direct Segmental Intra-hepatic Delivery Using a Rat Liver Hilar Clamp Model
Published on: April 2, 2017
A safe protocol of intermittent hilar vascular clamping for hepatic resection in cirrhosis
Hiroaki Nagano1, Shinichi Kishimoto, Shogo Kobayashi
1Department 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
Background/Aims:
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.
