Effects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liver

被引:112
作者
Wu, CC
Hwang, CR
Liu, TJ
Peng, FK
机构
[1] Department of Surgery, Taichung Veterans General Hospital, Section 3, Taichung
关键词
D O I
10.1002/bjs.1800830139
中图分类号
R61 [外科手术学];
学科分类号
摘要
Intermittent clamping of the hepatic pedicle during hepatectomy may reduce operative bleeding, but its limitations and long-term effects on the cirrhotic liver are unknown. Eighty-three patients with cirrhosis undergoing hepatectomy with repeated clamping for 15 min and declamping for 5 min were divided into three groups based on total clamping duration: group 1 less than 40 min (39 patients); group 2 40-80 min (28); group 3 more than 80 min (16). Larger tumours were associated with longer ischaemia times (P=0.002), longer operating times, greater operative blood loss and increased blood transfusion requirements (P<0.001), and resulted in higher postoperative levels of serum transaminases and lactic dehydrogenase (P<0.001). Operative morbidity and mortality rates, and the late hepatic failure rate, were not affected. The longest total ischaemia time was 204 min but the uppermost time limit for hepatic ischaemia remains to be determined.
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页码:121 / 124
页数:4
相关论文
共 18 条
[1]   LIVER RESECTIONS IN CIRRHOTIC-PATIENTS - A WESTERN EXPERIENCE [J].
BISMUTH, H ;
HOUSSIN, D ;
ORNOWSKI, J ;
MERIGGI, F .
WORLD JOURNAL OF SURGERY, 1986, 10 (02) :311-317
[2]  
CHILD CG, 1964, LIVER PORTAL HYPERTE, P1
[3]   PROLONGED INTERMITTENT CLAMPING OF THE PORTAL TRIAD DURING HEPATECTOMY [J].
ELIAS, D ;
DESRUENNES, E ;
LASSER, P .
BRITISH JOURNAL OF SURGERY, 1991, 78 (01) :42-44
[4]   PARTIAL HEPATIC RESECTION UNDER INTERMITTENT HEPATIC INFLOW OCCLUSION IN PATIENTS WITH CHRONIC LIVER-DISEASE [J].
EZAKI, T ;
SEO, Y ;
TOMODA, H ;
FURUSAWA, M ;
KANEMATSU, T ;
SUGIMACHI, K .
BRITISH JOURNAL OF SURGERY, 1992, 79 (03) :224-226
[5]  
FRANCO D, 1994, SURGERY LIVER BILIAR, V2, P1539
[6]   LIVER RESECTION WITH NORMOTHERMIC ISCHEMIA EXCEEDING 1-H [J].
HANNOUN, L ;
BORIE, D ;
DELVA, E ;
JONES, D ;
VAILLANT, JC ;
NORDLINGER, B ;
PARC, R .
BRITISH JOURNAL OF SURGERY, 1993, 80 (09) :1161-1165
[7]  
HUGUET C, 1978, SURG GYNECOL OBSTET, V147, P689
[8]   EXPERIMENTAL-STUDY OF THE PROTECTIVE EFFECT OF INTERMITTENT HEPATIC PEDICLE CLAMPING IN THE RAT [J].
ISOZAKI, H ;
ADAM, R ;
GIGOU, M ;
SZEKELY, AM ;
SHEN, M ;
BISMUTH, H .
BRITISH JOURNAL OF SURGERY, 1992, 79 (04) :310-313
[9]  
KIM YI, 1994, HEPATO-GASTROENTEROL, V41, P355
[10]   SURGERY FOR SMALL LIVER CANCERS [J].
MAKUUCHI, M ;
KOSUGE, T ;
TAKAYAMA, T ;
YAMAZAKI, S ;
KAKAZU, T ;
MIYAGAWA, S ;
KAWASAKI, S .
SEMINARS IN SURGICAL ONCOLOGY, 1993, 9 (04) :298-304