Ischemic preconditioning-induced hyperperfusion correlates with hepatoprotection after liver resection

作     者：Oleg Heizmann Georgios Meimarakis Andreas Volk Daniel Matz Daniel Oertli Rolf J Schauer 

作者机构：Department of Surgery University Hospital Basel Department of Surgery Klinikum of the Ludwig-Maximilians-University-Grosshadern University of Munich Department of Surgery University Hospital of Dresden Department of Surgery Academic Hospital of the Ludwig-Maximilians-University of Munich 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2010年第16卷第15期

页      面：1871-1878页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Supported by The Deutsche Forschungsgemeinschaft  No. DFG SCHA 857/1-1 

主　　题：Ischemic preconditioning Reperfusion injury Liver Surgery Liver blood flow 

摘      要：AIM:To characterize the impact of the Pringle ma-neuver (PM) and ischemic preconditioning (IP) on total blood supply to the liver following hepatectomies. METHODS: Sixty one consecutive patients who un-derwent hepatic resection under in flow occlusion were randomized either to receive PM alone (n = 31) or IP (10 min of ischemia followed by 10 min of reperfusion) prior to PM (n = 30). Quantification of liver perfusion was measured by Doppler probes at the hepatic artery and portal vein at various time points after reperfusion of remnant livers. RESULTS: Occlusion times of 33 ± 12 min (mean ± SD) and 34 ± 14 min and the extent of resected liver tissue (2.7 segments) were similar in both groups. In controls (PM), on reperfusion of liver remnants for 15 min, portal perfusion markedly decreased by 29% while there was a slight increase of 8% in the arterial blood flow. In contrast, following IP + PM the portal vein flow remained unchanged during reperfusion and a significantly increased arterial blood flow (+56% vs baseline) was observed. In accordance with a better postischemic blood supply of the liver, hepatocellular injury, as measured by alanine aminotransferase (ALT) levels on day 1 was considerably lower in group B compared to group A (247 ± 210 U/I vs 550 ± 650 U/I, P 0.05). Additionally, ALT levels were significantly correlated to the hepatic artery in ***: IP prevents postischemic flow reduction of the portal vein and simultaneously increases arterial perfusion, suggesting that improved hepatic macrocirculation is a protective mechanism following hepatectomy.