An experimental study of hepatic resection using an in situ hypothermic perfusion technique.
Recently, along with the progression of hepatic surgery, the in situ hypothermic perfusion technique has been used for major hepatic resection. The aim of this study was to elucidate the utility of the hypothermic perfusion technique in hepatic resection. Two experimental models: a Total Vascular Occlusion group (TVO) and a Total Vascular Occlusion under Hypothermic Perfusion group (HP) were utilized using adult mongrel dogs. An approximately 40-45% hepatic resection was performed under total vascular occlusion with a systemic and portal shunt. In the HP group, the liver was perfused through the portal vein with lactated ringer's solution at 4 degrees C. In the TVO group, hepatic resection was done without perfusion. Serum AST and ALT levels after reperfusion were significantly increased in the TVO group. From the change of serum hyaluronic acid and xanthine oxidase activity, sinusoidal endothelial cell function was maintained in HP more than in TVO. The mean arterial pressure, portal venous pressure and portal venous blood flow were maintained in HP after reperfusion. Examination of vascular permeability using monastral blue showed that vascular permeability of the small intestine, lung and liver was clearly increased in TVO. Chemiluminescense intensity of the hepatic venous blood after reperfusion gradually increased only in TVO. In addition, the chemiluminescense intensity of the hepatic venous blood congested in the liver increased markedly as vascular occlusion continued in TVO. The hepatic venous blood serum congested in the liver induced morphological changes in the human umbilical vein endothelial cells and increased their permeability. The SDS-PAGE of the hepatic venous blood serum congested in the liver revealed several proteins between 37 and 42 KD. The hypothermic perfusion technique in hepatic resection may be very useful in preserving the hepatocytes and sinusoidal endothelial cells and in maintaining stability of the systemic or hepatic circulation after reperfusion because of the cooling of the liver and the washing out of congested blood in the liver.