Assessment And Protection Of Hepatic Schemia-reperfusion Injury

Part1. A clinical research of indocyanine green clearance test in evaluating hepatic ischemia-reperfusion injuryObjective:To investigate the clinical significance of the value retention rate of indocyanine green at fifteen minutes(ICG R15) in evaluating hepatic ischemia-reperfusion injury(HIRI).Methods:The clinical data of46primary liver cancer patients who underwent partial hepatectomy from Jun.2011to Jun.2012in department of hepatic surgery anhui provincial hospital were retrospectively analyzed.23patients underwent partial hepatectomy with Pringle maneuver (PM group) and those of23patients treated by partial hepatectomy without Pringle maneuver (non-PM group). The preoperative and intraoperative indocyanine green clearance test (R15and intraR15), the chang of preoperative and intraoperative indocyanine green clearance test(AR15) and the liver function of postoperative were compared between the two groups.Results:IntraR15in non-PM group were significantly lower then those in the PM group (P<0.05) and AR15in non-PM group were significantly lower then those in the PM group(P<0.01),There were significantly differences in the levels of ALT and AST at the same time point after operation(P<0.05).Conclusion:ICG as a effective method in evaluating hepatic reserve function,to use AR15can evaluation of hepatic ischemia-reperfusion injury (HIRI) very well. Part2. Protective effect of S-Adenosylmethionine on hepatic ischemia-reperfusion injury during hepatectomy in the chronic HBV infection cirrhotic patients with hepatocellular carcinomaObjectives:To evaluate whether the treatment with SAMe could alleviate HIRI in patients who are undergoing partial hepatectomy, with the Pringle maneuver, in particular, for patients with hepatocellular carcinoma (HCC) associated with chronic Hepatitis B virus (HBV) infection and Cirrhotic.Materials and Methods:Eighty one chronic HBV infection patients with HCC undergoing partial hepatectomy with inflow occlusion were randomly divided into three groups. In pretreatment group (PR group, n=26), patients were given SAMe2hours before surgery. In posttreatment group (PO group, n=25), patients were given SAMe6hours after surgery and a control group (Control group=30), patients undergoing partial hepatectomy without SAMe. Preoperative, intraoperative and postoperative blood samples were taken to measure the plasma transaminase, bilirubin and cytokines, and compared between the three groups.Results:There are no intergroup statistical differences observed in age, gender, hepatic inflow occlusion time or the results of liver function tests. Preoperative administration of SAMe (PR group) significantly reduced Alanine transaminase(ALT), aspartate transferase(AST), total bilirubin (TBIL), direct bilirubin(DBIL) as compared with the other groups (PO and Control group); and in PO group TBIL and DBIL was significantly lower than Control group. Significant differences were also seen in interleukin-6(IL-6) and tumor necrosis factor-a (TNF-a) between PR group and the other groups. Postoperative liver reserve function as ICGR15determined before closing the abdomen (Post ICGR15) in PR group was the best among the three groups. The risk of complications and the hospital stay after surgery in PR group was significantly meliorated than the Control group. In addition, patients with cirrhosis had an acute change rate of difference value (D-value) in ALT and AST than noncirrhosis.Conclusions:Preoperative administer of SAMe is useful for reducing the HIRI in partial hepatectomy with continuous inflow occlusion, especially for pharmacological preconditioning and in patients who have Chronic HBV infection and cirrhosis.