간장 ( 肝臟 ) 및 담도 ( 膽道 ) : Hepatic Vascular Exclusion시 저온 관류가 혈역학 및 간 세포기능에 미치는 영향 = The Effect of Cold Perfusion on Hemodynamics and Hepatocyte Function During Hepatic Vascular ExclusionHepatic Vascular Exclusion시 저온 관류가 혈역학 및 간 세포기능에 미치는 영향

다국어 초록 (Multilingual Abstract)

Intraoperative bleeding is the main risk during liver resection. Hepatic inflow occlusion is one of the methods that can be used to reduce this risk. Hepatic Vascular Exclusion (HVE) associates portal triad cross clamping and occlusion of the inferior vena cava below and above the liver and it completely isolates the liver and retrohepatic vena cava from the rest of the circulation.
The hepatic vascular exclusion results in liver i hemia. To prevent ischemic liver injury, cold perfusion has been applied in almost all transplantation. However, there are some controversies about the hypothermic perfusion to protect ischemic injury. So, the author conducted an experiment to observe hepatic functional impairment and hemodynamic alteration during HVE and compared with that of cold saline perfusion (flushing 4'C Ringers lactate solution through the portal vein with the rate of 50 ml/min) group. We divided forteen mongoreal dogs into control (n = 7) and experiment group (n = 7) and observed mean arterial pressure, liver enzymes (aspartate aminotransferase, alanine aminotransferase, lactic dehydrogenase) and arterial ketone body ratio (KBR) during HVE and after removal of HVE. The result are as follows;
The mean arterial pressure decreased significantly in the both group after 30 min HVE, but recovered to relatively normal values at 30 min and 60 min after declamping. Aspartate aminotransferase increased during and after the HVE peroid in both groups, but there is no difference between two groups. Alanine aminotransferase increased during and after the HVE period in both group, but a lesser increase was observed in the experimental group. (p<0.01)
Lactic dehydrogenase increased during and after the HVE period in both group, a lesser increase was observed in the experimental group. The arterial KBR decreased markedly during the HVE period in both groups but recovered to preoperative values at 30 min and 60 min after declamping.
There is no difference between two groups. From these results, it is suggested that HVE is a safe and useful technique in major hepatic resection and hypothermic perfusion during HVE may be beneficial to prevent warm ischemic damage to hepatocyte but further studies willl be anticipated.