A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy.

BACKGROUND: blood loss during liver resection and the need for perioperative blood transfusions have negative impact on perioperative morbidity, mortality, and long-term outcomes. METHODS: a randomized controlled trial was performed on patients undergoing liver resection comparing hemihepatic vascular inflow occlusion, main portal vein inflow occlusion, and Pringle maneuver. The primary endpoints were intraoperative blood loss and postoperative liver injury. The secondary outcomes were operating time, morbidity, and mortality. RESULTS: a total of 180 patients were randomized into 3 groups according to the technique used for inflow occlusion during hepatectomy: the hemihepatic vascular inflow occlusion group (n = 60), the main portal vein inflow occlusion group (n = 60), and the Pringle maneuver group (n = 60). Only 1 patient in the hemihepatic vascular occlusion group required conversion to the Pringle maneuver because of technical difficulty. The Pringle maneuver group showed a significantly shorter operating time. There were no significant differences between the 3 groups in intraoperative blood loss and perioperative mortality. The degree of postoperative liver injury and complication rates were significantly higher in the Pringle maneuver group, resulting in a significantly longer hospital stay. CONCLUSIONS: all 3 vascular inflow occlusion techniques were safe and efficacious in reducing blood loss. Patients subjected to hemihepatic vascular inflow occlusion, or main portal vein inflow occlusion responded better than those with Pringle maneuver in terms of earlier recovery of postoperative liver function. As hemihepatic vascular inflow occlusion was technically easier than main portal vein inflow occlusion, it is recommended.

An in vivo rat model for assessment of extrahepatic metabolism.

INTRODUCTION: Xenobiotic metabolism in extrahepatic tissues has been extensively studied in vitro, but it is difficult to estimate in vivo the share of xenobiotic transformation in extrahepatic tissues for lack of a suitable approach. In this paper an in vivo rat model for assessment of extrahepatic metabolism is described, and the model was investigated using the conversion of lidocaine to monoethylglycinexylidide (MEGX). METHODS: The rats were anesthetized with ethyl ether inhalation. The liver was exposed, the liver artery ligated, and the portal vein was clamped at its distal end. The left hepatic lobe was partly excised along its inferior margin, and a heparinized silicone catheter, diameter 0.2 cm, was inserted into the portal and left hepatic veins to allow the recirculation of portal vein blood. A sham operation was performed in the control group. RESULTS: Phenol red test showed that hepatic blood supply was absolutely blocked in model rats. At 30 min after establishing the portal-cavum bypass, the renal function and electrolytes did not change, but serum glucose decreased by 64.4 +/- 30.4%; 30 min after intravenous administration of 1.0% lidocaine 2 mg x kg(-1), serum MEGX in model rats was 32.0 +/- 7.14% of that in the control group, which mostly existed in a free form and was not induced by phenobarbital pretreatment. DISCUSSION: The model is easy to establish and provides an in vivo method to study the extrahepatic metabolism of xenobiotics.