Hepatic Blood Inflow Occlusion Research Articles

A self-designed liver circle for on-demand Pringle's manoeuver in laparoscopic liver resection.

Background:Laparoscopic liver resection (LLR) allows minimal incisions and relatively quicker post-operative recovery, while intraoperative massive haemorrhage led to conversion to laparotomy. This study aimed to introduce a new, safe and convenient device to serve as Pringle's manoeuver according to the demand in LLR.Methods:A liver circle consisting of a hole and a round stem with an obtuse small head was made by medical silica gel. It was applied in LLR to perform on-demand Pringle's manoeuver and developed its function in inferior vena cava (IVC) occlusion. The time of performing Pringle's manoeuver by liver circle, extracorporeal tourniquet and endo intestinal clip under laparoscopic simulator and LLR was compared.Results:The liver circle was successfully applied to perform Pringle's manoeuver, IVC exposure and occlusion. It took less time in the occluding step of Pringle's manoeuver than the extracorporeal tourniquet (4.15 ± 0.35 s vs. 9.90 ± 1.15 s, P < 0.05) and the endo intestinal clip (4.15 ± 0.35 s vs. 47.91 ± 3.98 s, P < 0.05) under LLR. The total manipulating time for Pringle's manoeuver with liver circle remained the shortest, and the advantages were more obvious with increased frequencies of intermittent Pringle's manoeuver.Conclusion:The new-designed liver circle is more convenient compared to other techniques in performing Pringle's manoeuver, especially the intermittent Pringle's manoeuver in LLR. It can be used to perform on-demand hepatic blood inflow occlusion in every LLR by pre-circling the hepatoduodenal ligament to control bleeding during surgery. It can also be applied to expose the surgical field of vision and perform IVC occlusion to reduce intraoperative blood loss.

Differential Effects of Three Techniques for Hepatic Vascular Exclusion during Resection for Liver Cirrhosis on Hepatic Ischemia-Reperfusion Injury in Rats.

Background/Aims Hepatic ischemia-reperfusion (I/R) injury is a serious concern during hepatic vascular occlusion. The objectives of this study were to assess effects of three techniques for hepatic vascular occlusion on I/R injury and to explore the underlying mechanisms. Methods Liver cirrhotic rats had undertaken Pringle maneuver (PR), hemihepatic vascular occlusion (HH), or hepatic blood inflow occlusion without hemihepatic artery control (WH). Levels of tumor necrosis factor alpha (TNF-α), nuclear factor kappa B (NF-κB), toll-like receptor 4 (TLR4), TIR-domain-containing adapter-inducing interferon-β (TRIF), and hemeoxygenase 1 (HMOX1) were assayed. Results The histopathologic analysis displayed that liver harm was more prominent in the PR group, but similar in the HH and WH groups. The HH and WH groups responded to hepatic I/R inflammation similarly but better than the PR group. Mechanical studies suggested that TNF-α/NF-κB signaling and TLR4/TRIF transduction pathways were associated with the differential effects. In addition, the HH and WH groups had significantly higher levels of hepatic HMOX1 (P < 0.05) than the PR group. Conclusions HH and WH confer better preservation of liver function and protection than the Pringle maneuver in combating I/R injury. Upregulation of HMOX1 may lead to better protection and clinical outcomes after liver resection.

Impact of hepatic blood inflow occlusion without hemihepatic artery control on tumor suppression and liver function in rat liver cancer model

Objective To study the effect of hepatic blood inflow occlusion without hemihepatic artery control on tumor suppression and liver function in rat liver cancer model. Methods Thirty SD rats were randomly divided into total hepatic inflow occlusion control group, hepatic vascular occlusion group, and hepatic blood inflow occlusion without hemihepatic artery control group. Three days after liver cancer moldel was established, the blood flow reperfusion was performed on the livers after 60 min of hepatic vascular occlusion. Five days after reperfusion, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB), and superoxide dismutase (SOD) and malondialdehyde (MDA) in liver tissues were determined. Liver cell apoptosis rate and tumor suppression rate were calculated. Results In hepatic vascular occlusion group and hepatic blood inflow occlusion without hemihepatic artery control group, serum ALT and AST levels were significantly lower, and ALB levels were significantly higher than in control group [(70.97±8.62) vs. (72.04±8.54) vs. (268.26±46.39) IU/L, (386.86±50.28) vs. (392.53±22.47) vs. (1 109.24±279.35) IU/L, (29.54±2.16) vs. (28.63±2.27) vs. (25.29±2.13) g/L, t=13.222, 8.048, 4.430, 13.151, 8.087 and 3.393, P=0.001, 0.008, 0.018, 0.000, 0.008, 0.024]. In hepatic vascular occlusion group and hepatic blood inflow occlusion without hemihepatic artery control group, liver tissue SOD levels were significantly higher, and MDA and liver cell apoptosis rate were significantly lower than in control group [(152.32±16.21) vs. (148.47±15.24) vs. (89.12±9.45) U/mgprot, (18.36±3.14) vs. (19.32±2.95) vs. (48.36±5.23) nmol/mg, (14.35±1.45)% vs. (15.12±1.54)% vs. (25.14±2.14)%, t=10.651, 15.552, 13.200, 10.466, 15.294 and 12.018, P=0.001, 0.001, 0.001, 0.001, 0.001, 0.001]. In hepatic vascular occlusion group and hepatic blood inflow occlusion without hemihepatic artery control group, tumor weight was significantly reduced as compared with control group [(1.83±0.32) vs. (1.90±0.35) vs. (2.62±0.41) g, t=4.803, and 4.224, P=0.008, 0.018]. There were no statistically significant differences in ALT, AST, SOD, MDA, liver cell apoptosis rate, tumor weight, and tumor suppression rate between hepatic vascular occlusion group and hepatic blood inflow occlusion without hemihepatic artery control group. Conclusion Hepatic blood inflow occlusion without hemihepatic artery control can reduce liver ishemia-reperfusion injury in rat liver cnacer model, promote tumor suppression effect, and the operation security is higher than hepatic vascular occlusion. Key words: Carcinoma, hepatocellular; Ischemia-reperfusion; Hepatic blood inflow occlusion without hemihepatic artery control; Liver function

Use of hepatic blood inflow occlusion and hemihepatic artery retention in liver resection for hepatocellular carcinoma

Background: To investigate the value and significance of the modified Pringle method in liver resection treatment for hepatocellular carcinoma (HCC). Methods: In this retrospective observational study, we analyzed 94 cases of HCC treated with hepatic resection in our department between January 2006 and November 2013. The patients were divided into two groups by method of hepatic blood flow occlusion used (modified Pringle, 56 cases; Pringle, 38 cases). The following data were collected: intraoperative blood loss; blood transfusion volume (including red blood cells and plasma); hepatic portal blocking time; operation time; and liver function at 1, 3, 5, and 7 days after the operation. The postoperative complications and length of hospital stay of the two groups were then compared. Results: There was no significant difference between the two groups in blood loss amount, blood transfusion volume, occlusion time, operation time, operation method, postoperative complications, or postoperative hospital stay length (P>0.05). However, the modified Pringle group demonstrated significantly faster postoperative recovery from hepatic injury (P Conclusions: Use of the modified Pringle method in liver resection allows for faster postoperative recovery from liver injury, making it especially suitable for patients with HCC and concomitant cirrhosis.

Use of hepatic blood inflow occlusion and hemihepatic artery retention in liver resection for hepatocellular carcinoma

Use of hepatic blood inflow occlusion and hemihepatic artery retention in liver resection for hepatocellular carcinoma

Attenuation of Reperfusion-Induced Hepatocyte Apoptosis is Associated with Reversed bcl-2/bax Ratio in Hemi-Hepatic Artery-Preserved Portal Occlusion

This study aimed to examine the hepatocyte apoptosis in a hepatic blood inflow occlusion rat model without hemi-hepatic arterial control and its association with the expressions of the apoptosis-regulating genes bcl-2 and bax. Wistar rats were equally and randomly assigned to undergo sham operation (control group, n = 8), Pringle's maneuver (group PR, n = 32), hemi-hepatic occlusion (group HH, n = 32), or hemi-hepatic artery-preserved portal occlusion (group HP, n = 32). The hepatic blood inflow was interrupted for 30 min using a microvascular clip in the three experimental groups. The clips were removed to achieve hepatic reperfusion for up to 24 h. Blood samples and liver specimens were collected following reperfusion to perform pathologic examination, serum transferase assay, apoptosis analysis, and determination of bcl-2 and bax mRNA and protein expressions. The reperfusion-related hepatocytic injuries were more severe in the PR group than in the HH and HP groups, both pathologically and biochemically. More reperfused hepatocytes became apoptotic in the PR group than in the HH and HP groups. However, the values of the HH and HP groups were comparable in cellularity, levels of serum transferases, and apoptosis rate following reperfusion. The ratios of bcl-2/bax were reversed, which was more evident in the HH and HP groups than in the PR group. Hemi-hepatic artery-preserved portal occlusion had little effect on hepatocyte apoptosis compared with Pringle's maneuver and caused minor ischemia-reperfusion injury as shown by the reversed bcl-2/bax ratio.

Hepatic blood inflow occlusion without hemihepatic artery control in treatment of hepatocellular carcinoma

To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC). Fifty-nine patients with HCC were divided into 3 groups based on the technique used for achieving hepatic vascular occlusion: group 1, vascular occlusion was achieved by the Pringle maneuver (n = 20); group 2, by hemihepatic vascular occlusion (HVO) (n = 20); and group 3, by BIOwHAC (n = 19). We compared the procedures among the three groups in term of operation time, intraoperative bleeding, postoperative liver function, postoperative complications, and length of hospital stay. There were no statistically significant differences (P > 0.05) in age, sex, pathological diagnosis, preoperative Child's disease grade, hepatic function, and tumor size among the three groups. No intraoperative complications or deaths occurrred, and there were no significant intergroup differences (P > 0.05) in intraoperative bleeding, hepatic function change 3 and 7 d after operation, the incidence of complications, and length of hospital stay. BIOwHAC and Pringle maneuver required a significantly shorter operation time than HVO; the difference in the serum alanine aminotransferase or aspartate aminotransferase levels before and 1 d after operation was more significant in the BIOwHAC and HVO groups than in the Pringle maneuver group (P < 0.05). BIOwHAC is convenient and safe; this technique causes slight hepatic ischemia-reperfusion injury similar to HVO.

The effect of hepatic blood inflow occlusion on hepatic cancer treated with diode-laser thermocoagulation

To assess the effect of temporary occlusion of hepatic blood inflow on hepatic cancer treated with diode-laser induced thermocogation (LITT). The carcinoma Walker-256 was implanted in 40 SD rat livers. Twelve days later, the animals were randomly divided into 4 groups. Group A received LITT alone; group B received hepatic artery temporary occlusion during LITT; group C received portal vein temporary occlusion during LITT; group D received hepatic artery and portal vein temporary occlusion during LITT. Tumors were exposed to 810 nm diode-laser light at 0.95 watts for 10 min from a scanner tip applicator placed in the tumor. At the same time, the intrahepatic temperature distribution in rats with liver tumors was measured per 2 min during thermocoagulation. Tumor control was examined immediately 7 and 14 d after thermocoagulation. There was significant difference of intrahepatic temperature distribution in rats with liver tumors among the 4 groups (P<0.05) except when group C samples were compared with group D samples at each time point, and group B samples were compared with group C samples at 120 s (P>0.05). Light microscopic examination of the histologic section samples revealed three separate zones: regular hyperthermic coagulation necrosis zone, transition zone and reference zone. Compared with the samples in group A and group B, group C and group D samples had more clear margin among the three zones. The hepatic blood inflow occlusion, especially portal vein hepatic blood inflow occlusion, or all hepatic blood inflow occlusion considerably increased the efficacy of LITT in the treatment of liver cancer.

Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis.

Hepatic blood inflow occlusion during hepatectomy may influence postoperative liver regeneration. The aim of this study was to investigate the influence of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in thioacetamide-induced cirrhotic rats. Forty-three cirrhotic Wistar-Furth rats were randomly assigned to three groups. Rats in group 1 underwent 64 per cent hepatectomy alone, those in group 2 were subjected to 15 min hepatic blood inflow occlusion followed by 64 per cent hepatectomy, and animals in group 3 were subjected to 30 min inflow occlusion followed by 64 per cent hepatectomy. Liver function, 5-bromo-2'-deoxyuridine (BrdU) labelling index and percentage of initial liver weight on days 1, 2 and 7 posthepatectomy were assessed. Rats in groups 1 and 2 had a significantly higher serum albumin level and a markedly lower alanine aminotransferase level than animals in group 3 on day 1 posthepatectomy (P < 0.05). There was no significant difference in the serum level of total bilirubin of the three groups on days 1, 2 and 7. The BrdU labelling index was significantly higher in groups 1 and 2 than in group 3 animals on day 1 posthepatectomy (P < 0.01 and P < 0.05 respectively). Percentages of initial liver weight were similar in groups 1, 2 and 3 on days 1, 2 and 7 after hepatectomy. Hepatic blood inflow occlusion for up to 30 min suppressed DNA synthesis and hepatocyte proliferation at an early posthepatectomy stage and consequently delayed recovery of liver function in cirrhotic rats. However, it did not affect restoration of liver mass or survival after 64 per cent hepatectomy.