T Ohya1, S Ohwada, Y Kawashima. 1. Second Department of Surgery, Gunma University School of Medicine, Gunma Japan.
Abstract
BACKGROUND: An oxygen supply is necessary to maintain the energy metabolism of hepatic cells even at low temperatures in total hepatic vascular exclusion (THVE). Little has been written regarding the effect of an oxygenated perfusate for hypothermic perfusion in THVE, required for extended hepatectomy. STUDY DESIGN: Adult mongrel dogs (n=15) were used. Total hepatic vascular exclusion with active venovenous bypass was maintained for 60 minutes and 75 percent of the liver was resected. The LR group (n=7) was perfused using a 4 degrees C Ringer's lactate solution, and the FC43 group (n=8) with 4 degrees C oxygenated perfluorochemical. Blood samples from the hepatic vein were collected in order to measure alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), purine nucleoside phosphorylase (PNP), and NH(3). RESULTS: At every sampling point after hepatectomy, the serum AST levels of hepatic venous blood were significantly lower (p<0.05) in the FC43 group than in the LR group. Serum ALT, LDH, and PNP levels were significantly lower (p<0.05) in the FC43 group than in the LR group immediately after reperfusion. Plasma NH(3) levels were significantly lower (p<0.05) in the FC43 group than in the LR group, 30 minutes and two hours after reperfusion. CONCLUSIONS: Hypothermic perfusion using oxygenated perfluorochemical prevents hepatic cell damage during in situ extended hepatectomy.
BACKGROUND: An oxygen supply is necessary to maintain the energy metabolism of hepatic cells even at low temperatures in total hepatic vascular exclusion (THVE). Little has been written regarding the effect of an oxygenated perfusate for hypothermic perfusion in THVE, required for extended hepatectomy. STUDY DESIGN: Adult mongrel dogs (n=15) were used. Total hepatic vascular exclusion with active venovenous bypass was maintained for 60 minutes and 75 percent of the liver was resected. The LR group (n=7) was perfused using a 4 degrees C Ringer's lactate solution, and the FC43 group (n=8) with 4 degrees C oxygenated perfluorochemical. Blood samples from the hepatic vein were collected in order to measure alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), purine nucleoside phosphorylase (PNP), and NH(3). RESULTS: At every sampling point after hepatectomy, the serum AST levels of hepatic venous blood were significantly lower (p<0.05) in the FC43 group than in the LR group. Serum ALT, LDH, and PNP levels were significantly lower (p<0.05) in the FC43 group than in the LR group immediately after reperfusion. Plasma NH(3) levels were significantly lower (p<0.05) in the FC43 group than in the LR group, 30 minutes and two hours after reperfusion. CONCLUSIONS:Hypothermic perfusion using oxygenated perfluorochemical prevents hepatic cell damage during in situ extended hepatectomy.