The Study Of Hepatic Blood Inflow Occlusion Without Hemihepatic Artery Control

ObjectiveLiver resection may be complicated by intraoperative bleeding.Effective occlusion of blood inflow with or without outflow control is very important to reduce intraoperative bleeding in the liver operation.However,hepatic vascular occlusion will undoubtedly result in ischemia reperfusion injury and impair liver function.We compared hepatic blood inflow occlusion without hemihepatic artery control with Pringle and hemihepatic vascular occlusion maneuver from animal experiment to clinical operation,tried to find the most appropriate method for achieving hepatic vascular control in a given patient.Materials and MethodsExperiment 1:We used Wistar rats to establish animal operation models by Pringle maneuver,hemihepatic vascular occlusion and hepatic blood inflow occlusion without hemihepatic artery control.And we found the operation success rate,rat mortality and ideal occlusion time before the formal experiment.Experiment 2:128 Wistar rats were randomly divided into 4 groups.There were false operation group(group SO,n=8),Pringle group(group PR,n=40),hemihepatic vascular occlusion group(group HH,n=40)and hepatic blood inflow occlusion without hemihepatic artery control group(group WH,n=40)respectively.Each group(except group SO)divided into 5 sub-groups(reperfusion 1,2,6,24 and 72h,n=8).After hepatic vascular occlusion 30 minutes with three methods,the liver blood flow was reperfused.After the reperfusion 1,2,6and 24h,serum AST and ALT were assessed and liver tissue were analyzed SOD,MDA,bcl-2,Bax,Fas mRNA expression,cell apoptosis and pathology.The rat mortality was analyzed after reperfusion 72h.Experiment 3:59 HCC patients were divided into Pringle group(n=20), hemihepatic vascular occlusion group(n=20)and hepatic blood inflow occlusion without hemihepatic artery control group(n=19).Operation time,total intra-operative blood loss,post-operative liver functions,post-operative complication and length of hospital stay were analyzed.ResultsExperiment 1:101 rats were operated and each group 24 rats had been operated successfully.Operation success rate were group PR 80.0%(24/30),group HH 63.2% (24/38),group WH 72.7%(24/33).Each group the rat survival rate were all 100%(8/8) on 15 minutes hepatic ischemia followed by 24hour reperfusion.The rat survival rate of group PR was only 37.5%(3/8)(there were hepatocyte spotty necrosis,ballon degeneration and acidophilic necrosis in liver pathological changes),group HH was 100%(0/8),group WH was 87.5%(7/8)on 45 minutes hepatic ischemia followed by 24 hour reperfusion.The rat survival rate of group PR was 87.5%(7/8)(the liver pathological changes got better than on 45 minutes hepatic ischemia followed by 24 hour reperfusion significantly),group HH was 100%(8/8),group WH was 100%(8/8) on 30 minutes hepatic ischemia followed by 24hour reperfusion.Experiment 2:On the each time of the reperfusion,serum AST and ALT,liver tissue MDA,Bax,Fas mRNA expression and cell apoptosis of group PR were all higher than them of group HH and group WH(P＜0.01),Liver tissue MDA and bcl-2 mRNA expression of group HH and group WH higher than the group PR(P＜0.01). The serum AST and ALT,liver tissue SOD,MDA,bcl-2,Bax,Fas mRNA expression and cell apoptosis of group HH had no difference significantly with group WH(P＞0.05).The rat survival rate of group PR was 87.5%(7/8),group HH was 100%(8/8), group WH was 100%(8/8)on 30 minutes hepatic ischemia followed by 72 hour reperfusion.Experiment 3:The patients sex,age,pathologic diagnosis,preoperartion Child-Pugh classification,preoperartative liver function test,tumor size of three groups had no differences significantly(P＞0.05).All patients were operated successfully by three methods.Total intra-operative blood loss,liver functions on post-operative 3d and 7d,post-operative complication and length of hospital stay of three groups had no difference significantly(p＞0.05).But the operation time of hepatic blood inflow occlusion without hemihepatic artery control group and Pringle group were shorter significantly than hemihepatic vascular occlusion group.The liver functions on post-operative 1d of hepatic blood inflow occlusion without hemihepatic artery control group and hemihepatic vascular occlusion group were better than Pringle group(p＜0.05).ConculsionHepatic blood inflow occlusion without hemihepatic artery control is simplicity and safety.Hepatic blood inflow occlusion without hemihepatic artery control and hemihepatic vascular occlusion can reduce the hepatic ischemia-reperfusion injury.Hepatic blood inflow occlusion without hemihepatic artery control is worth expanding because of its simplicity,safety and liver injury minor.