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Intermittent hepatic pedicle clamping reduces liver and lung injury
N Kimura1, R Muraoka, T Horiuchi
1Second Department of Surgery, Fukui Medical University, Fukui, Matsuoka, 910-11, Japan.
Background:
Temporary occlusion of the hepatic hilum is used to control hemorrhage during liver resection, but can result in widespread organ dysfunction.
Materials And Methods:
Adult male Sprague-Dawley rats were subjected to either continuous (Group C) or intermittent (Group R) hepatic ischemia. The total ischemia time (60 min) was divided into four 15-min periods in Group R. Blood and lung tissue specimens were collected 2 h after the induction of ischemia (early phase), and 24 h after the termination of ischemia (late phase). Plasma lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) concentrations were measured. Histologic sections were studied using hematoxylin and eosin, as well as naphthol AS-D chloroacetate esterase techniques.
Results:
In the early phase, LDH, ALT, TNF-alpha, and IL-6 concentrations were significantly higher in Group C than in Group R. Pulmonary septal thickening and polymorphonuclear leukocyte infiltration were less severe in Group R than in Group C. These differences were significant in the late phase.
Conclusions:
Intermittent hepatic pedicle clamping reduces the ischemia-reperfusion injury not only to the liver but also to the lungs. This technique may improve the outcome in patients undergoing liver resection.