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Changes in serum amylase level following hepatic resection in chronic liver disease
S Miyagawa1, M Makuuchi, S Kawasaki
1First Department of Surgery, Shinshu University, School of Medicine, Matsumoto, Japan.
Objective:
Factors that were likely to cause hyperamylasemia following hepatic resection were studied.
Design:
Case-comparison study.
Setting:
Institutional practice.
Patients:
Seventy-one patients who underwent hepatic resection because of primary or secondary liver tumors and other benign disease, and who had no history of pancreatitis, were divided into four groups. Patients were divided into groups according to the presence or absence of underlying liver disease and the vascular occlusion methods used during hepatic resection (Pringle maneuver or the hemihepatic vascular occlusion technique). The Pringle maneuver was chosen for patients in whom the duration of liver parenchymal transection was expected to be short and/or the hepatic hilum had severe adhesion precluding the safe dissection of the hepatic artery and portal vein.
Main Outcome Measures:
Serum amylase levels were measured on the preoperative day and on postoperative days 1, 2, 4, 6, 7, 10, and 14. Preoperative liver function, operative blood loss, operative time, and vascular occlusion time were examined.
Results:
Patients with chronic liver disease (CLD group) had high serum amylase levels during the preoperative and postoperative periods. Patients in the CLD group who underwent the Pringle maneuver (Pringle-L group) had significantly elevated postoperative serum amylase levels in comparison with their preoperative serum amylase levels. Pancreatitis developed in two patients in the Pringle-L group--one of them died.
Conclusion:
These results strongly suggest that prolonged complete occlusion of the portal vein for hepatectomy in patients with chronic liver disease has a serious influence on postoperative serum amylase levels.