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Article: Tolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors

TitleTolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors
Authors
Issue Date1999
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.com
Citation
Archives Of Surgery, 1999, v. 134 n. 5, p. 533-539 How to Cite?
AbstractBackground: Hepatectomy can be performed with a low mortality rate, but massive hemorrhage during the operation remains a potentially lethal problem. The Pringle maneuver is traditionally used during hepatectomy to reduce blood loss, but the effect on the metabolic function of hepatocytes is potentially harmful. Although our randomized study showed that an intermittent Pringle maneuver is safe and effective during hepatectomy, the upper limit of the duration of the Pringle maneuver is not known. Hypothesis: The liver can tolerate intermittent Pringle maneuver if the duration is not excessive. Design: From July 20, 1995, to November 25, 1997, 112 patients underwent hepatectomy for liver tumors. The data of 50 patients who had hepatectomy without the Pringle maneuver were compared with those of 62 patients who had a liver transection using a Pringle maneuver for 20 minutes and a 5-minute clamp-free interval. The data were collected prospectively. Main Outcome Measures: The surface area of liver transection was measured, and blood loss during liver transection per centimeter square of transection area was calculated. Routine liver biochemical tests, arterial ketone body ratio (AKBR), and plasma cytokine-interleukin (IL) 1α, 1β, 2, and 6, and tumor necrosis factor α-levels were measured before and after the operation. The morbidity and hospital mortality rates were also compared among the patients with different ischemic durations and those without an intermittent Pringle maneuver. Setting: Tertiary referral center. Results: The cutoff point of accumulated ischemic time that induced substantial liver damage, as shown by the postoperative recovery rate of the AKBR, was found to be 120 minutes. Compared with the control group, the patients whose accumulated ischemic time was shorter than 120 minutes had less blood loss related to transection area (10 mL/cm2 vs 22 mL/cm2; P < .001), less blood transfused (0 L vs 0.6 L; P = .004), a shorter transection time related to transection area (2.0 min/cm2 vs 2.8 min/cm2; P = .002), a significantly higher AKBR in the first 2 hours after liver transection, an equal recovery rate of the AKBR, and a comparable increase of the plasma level of IL-6 postoperatively. For the patients whose accumulated ischemic time was longer than 120 minutes, blood loss from the transection area was less than for the control group (14 mL/cm2 vs 22 mL/cm2; P < .05), but the transection time related to the transection area and the blood transfusion volume did not differ from those of the control group. Furthermore, they had a significantly lower recovery rate of the AKBR and higher plasma levels of IL-6 postoperatively than the control group. Conclusion: The upper limit of tolerance of the liver to intermittent Pringle maneuver is 120 minutes.
Persistent Identifierhttp://hdl.handle.net/10722/49414
ISSN
2014 Impact Factor: 4.926
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMan, Ken_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorNg, IOLen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorYu, WCen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2008-06-12T06:41:58Z-
dc.date.available2008-06-12T06:41:58Z-
dc.date.issued1999en_HK
dc.identifier.citationArchives Of Surgery, 1999, v. 134 n. 5, p. 533-539en_HK
dc.identifier.issn0004-0010en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49414-
dc.description.abstractBackground: Hepatectomy can be performed with a low mortality rate, but massive hemorrhage during the operation remains a potentially lethal problem. The Pringle maneuver is traditionally used during hepatectomy to reduce blood loss, but the effect on the metabolic function of hepatocytes is potentially harmful. Although our randomized study showed that an intermittent Pringle maneuver is safe and effective during hepatectomy, the upper limit of the duration of the Pringle maneuver is not known. Hypothesis: The liver can tolerate intermittent Pringle maneuver if the duration is not excessive. Design: From July 20, 1995, to November 25, 1997, 112 patients underwent hepatectomy for liver tumors. The data of 50 patients who had hepatectomy without the Pringle maneuver were compared with those of 62 patients who had a liver transection using a Pringle maneuver for 20 minutes and a 5-minute clamp-free interval. The data were collected prospectively. Main Outcome Measures: The surface area of liver transection was measured, and blood loss during liver transection per centimeter square of transection area was calculated. Routine liver biochemical tests, arterial ketone body ratio (AKBR), and plasma cytokine-interleukin (IL) 1α, 1β, 2, and 6, and tumor necrosis factor α-levels were measured before and after the operation. The morbidity and hospital mortality rates were also compared among the patients with different ischemic durations and those without an intermittent Pringle maneuver. Setting: Tertiary referral center. Results: The cutoff point of accumulated ischemic time that induced substantial liver damage, as shown by the postoperative recovery rate of the AKBR, was found to be 120 minutes. Compared with the control group, the patients whose accumulated ischemic time was shorter than 120 minutes had less blood loss related to transection area (10 mL/cm2 vs 22 mL/cm2; P < .001), less blood transfused (0 L vs 0.6 L; P = .004), a shorter transection time related to transection area (2.0 min/cm2 vs 2.8 min/cm2; P = .002), a significantly higher AKBR in the first 2 hours after liver transection, an equal recovery rate of the AKBR, and a comparable increase of the plasma level of IL-6 postoperatively. For the patients whose accumulated ischemic time was longer than 120 minutes, blood loss from the transection area was less than for the control group (14 mL/cm2 vs 22 mL/cm2; P < .05), but the transection time related to the transection area and the blood transfusion volume did not differ from those of the control group. Furthermore, they had a significantly lower recovery rate of the AKBR and higher plasma levels of IL-6 postoperatively than the control group. Conclusion: The upper limit of tolerance of the liver to intermittent Pringle maneuver is 120 minutes.en_HK
dc.format.extent420 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.comen_HK
dc.relation.ispartofArchives of Surgeryen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshHepatectomy - methodsen_HK
dc.subject.meshLiver - physiology - surgeryen_HK
dc.subject.meshLiver Neoplasms - blood - surgeryen_HK
dc.subject.meshPostoperative Complications - prevention & controlen_HK
dc.subject.meshProspective Studiesen_HK
dc.titleTolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumorsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-0010&volume=134&issue=5&spage=533&epage=539&date=1999&atitle=Tolerance+of+the+liver+to+intermittent+pringle+maneuver+in+hepatectomy+for+liver+tumorsen_HK
dc.identifier.emailMan, K: kwanman@hku.hken_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailNg, IOL: iolng@hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityMan, K=rp00417en_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityNg, IOL=rp00335en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1001/archsurg.134.5.533en_HK
dc.identifier.pmid10323426-
dc.identifier.scopuseid_2-s2.0-0032915970en_HK
dc.identifier.hkuros40605-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0032915970&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume134en_HK
dc.identifier.issue5en_HK
dc.identifier.spage533en_HK
dc.identifier.epage539en_HK
dc.identifier.isiWOS:000080173400013-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridMan, K=7101754072en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridNg, IOL=7102753722en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridYu, WC=37022285400en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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