Study On The Safety Of Regional Hepatic Blood Flow Blocking Technique In Hepatic Surgery

Objectives:Objective to investigate the application and safety of regional hepatic inflow occlusion in hepatectomy.Methods:(一)Experience summary of 60 cases of hepatectomy with regional hepatic blood flow blockade:Retrospective analysis of the Department of Hepatobiliary and Pancreatic Surgery,Second People’s Hospital of Yunnan Province,from January 2018 to June 2019 by the same surgeon who used regional hepatic blood flow.Clinical data and experience of 60 patients undergoing hepatectomy with blocking technique.(二)Study on the safety time limit of rat regional hepatic blood flow blocking:male SD rats were randomly divided into 4 groups:group A was the sham operation group(n=16),and group B was the intermittent regional hepatic blood flow blocking group(n=16),group C is the group with persistent regional hepatic blood flow block(n=16),and group D is the group of 24h after continuous regional hepatic blood flow is blocked(n=16).The intermittent blocking method uses a method of blocking the left liver and middle hepatic lobe for 5 minutes to control the blood flow of the left liver and middle hepatic lobe for a total of 4 times;the continuous blocking method directly blocks the left liver and middle hepatic lobe to a predetermined time.After blocking for 30min,60min,90min,120min,1ml of blood was collected by cardiac puncture to measure the alanine aminotransferase and aspartate aminotransferase(ALT,AST)values,and 2 pieces of fresh left liver tissue were collected,and one piece was tested for liver tissue ATPase activity.Another piece of paraffin embedded HE staining.Results:(一)All 60 hepatectomy patients successfully implemented the regional(half-hepatic)hepatic blood flow blocking technique and completed the operation.The operation time was 124.2±47.6min,the hepatic blood flow blocking time was 39.9±13.4min,and the intraoperative blood loss was 327.3±222.4ml,postoperative hospital stay 10.1±3.0d,intraoperative blood transfusion in 17 cases,postoperative pleural efusion in 5 cases,incision infection in 2 cases,biliary fistula in 0 cases,lung infection in 2 cases,no liver failure,postoperative Patients with bleeding and death.(二)Serum ALT and AST values gradually increased with the prolongation of blood flow blocking time.At 30 min,there were statistically significant differences between image points A and B,B and C,A and D,and D and C(P<0.05);At 60min and 90min,the points A and B,B and C,A and D,D and C,and B and D groups were statistically significant(P<0.05);the liver function damage in group B increased with the increase in reflow.There was a linear positive correlation;fresh liver tissue ATPase activity detection,as the blocking time was extended,ATPase activity gradually decreased;blocking time 120min,comparison between the C and D group,the difference was not statistically significant(P>0.05).The HE stained tissue sections showed partial necrosis of the ischemic liver tissue after continuous blocking for 90 minutes;large necrosis appeared after blocking time of 120 minutes,and the structure of the liver cord was unclear.Conclusions:(一)Using Glisson system extrathecal regional hepatic blood flow blocking technology,which has high safety and success rate,and can avoid remaining liver ischemia-reperfusion injury and abdominal organ congestion;cirrhosis is blocked for 30 minutes at a time,and normal liver is at a time Blocking for 60 minutes is safe and feasible.It is beneficial to reduce intraoperative blood loss,reduce intraoperative abdominal organ congestion,and improve surgical accuracy.It can be routinely promoted in clinical practice.(二)The ischemia-reperfusion injury caused by liver reflow is obvious.The more the number of reflow,the more serious the liver damage;when the continuous area of hepatic blood flow is blocked for more than 90 minutes,the liver tissue will experience obvious necrosis,even if it is reflowed.It is difficult to restore liver tissue activity.It is speculated that the safe time limit of continuous regional hepatic blood flow blocking in SD rats is about 90 minutes;within the safe time limit of blocking,compared with ischemia-reperfusion injury,the liver can better tolerate ischemia and hypoxia.