紀要論文 Ischemic time by the intermittent occlusion of hepatic inflow (Pringle’s maneuver) influences surgical outcome after hepatectomy

Nanashima, Atsushi  ,  Sumida, Yorihisa  ,  Murakami, Goushi  ,  Sawai, Terumistu  ,  Nagayasu, Takeshi

60 ( 3 )  , pp.109 - 117 , 2016-04 , Nagasaki University School of Medicine
ISSN:00016055
内容記述
Background: Intermittent occlusion of hepatic inflow, so-called Pringle’s maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated with hepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p<0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p<0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p<0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p<0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay.
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http://naosite.lb.nagasaki-u.ac.jp/dspace/bitstream/10069/36573/1/ActMed60_109.pdf

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