Equilibre acido-basique et exclusion vasculaire du foie : étude de 30 hépatectomies étendues

Delva, E.; Barberousse, J.P.; Boucherez, C.; Camus, Y.; Huguet, C; Guilmet, C

doi:10.1016/s0750-7658(83)80005-7

Cited by 2 publications

(5 citation statements)

References 14 publications

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“…Normal livers tolerate up to one hour of warm ischemia while in diseased livers [i.e., chemotherapy, cholestasis, steatosis, sinusoidal obstruction syndrome (SOS)] ischemia periods must be shorter [45,46]. Transient liver biochemical dysfunction always occurs after hepatic resection with or without clamping.…”

Section: Vascular Clamping Techniques: Outflow Occlusionmentioning

confidence: 99%

“…If liver ischemia/reperfusion (I/R) injury can be reduced, clamping duration can be safely prolonged, allowing a more prudent, unhurried transection of liver parenchyma and consequent decrease in the risk of technical error, bile leakage and intra- and postoperative hemorrhage. Clearance of blood from the liver without concomitant cooling severely aggravates liver I/R injury [45]. …”

Section: Vascular Clamping Techniques: Outflow Occlusionmentioning

confidence: 99%

“…In instances where the projected clamping is prolonged or in cirrhotic livers, some authors have advocated using hypothermia in order to protect the liver [45]. Liver hypothermia is achieved by infusing the liver with a protective solution under TVE.…”

Section: Vascular Clamping Techniques: Outflow Occlusionmentioning

confidence: 99%

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Vascular clamping in liver surgery: physiology, indications and techniques

Chouillard

Gumbs

Cherqui³

2010

Ann Surg Innov Res

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This article reviews the historical evolution of hepatic vascular clamping and their indications. The anatomic basis for partial and complete vascular clamping will be discussed, as will the rationales of continuous and intermittent vascular clamping.Specific techniques discussed and described include inflow clamping (Pringle maneuver, extra-hepatic selective clamping and intraglissonian clamping) and outflow clamping (total vascular exclusion, hepatic vascular exclusion with preservation of caval flow). The fundamental role of a low Central Venous Pressure during open and laparoscopic hepatectomy is described, as is the difference in their intra-operative measurements. The biological basis for ischemic preconditioning will be elucidated. Although the potential dangers of vascular clamping and the development of modern coagulation devices question the need for systemic clamping; the pre-operative factors and unforseen intra-operative events that mandate the use of hepatic vascular clamping will be highlighted.

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Section: Vascular Clamping Techniques: Outflow Occlusionmentioning

confidence: 99%

Section: Vascular Clamping Techniques: Outflow Occlusionmentioning

confidence: 99%

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Vascular clamping in liver surgery: physiology, indications and techniques

Chouillard

Gumbs

Cherqui³

2010

Ann Surg Innov Res

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“…As a result, hepatocytes will be in a low-energy status and mainly obtain energy from anaerobic glycolysis (13,18,22,32,33). These events reduce the clearance and uptake of lactate (3,5,13,14) and increase lactate production (2,22) in the liver, causing postresection hyperlactatemia (19,27). The hepatic production of bicarbonate from organic acids (including lactic acid) is decreased (21,32), and HCO 3…”

Section: Discussionmentioning

confidence: 99%

“…After EH, the hepatic artery flow decreases, and the portal vein flow increases for every 100 g of remnant liver volume (RLV) (7,11). This leads to hypoxia in the RLV (5,10,31). Low oxygen supply to the remnant liver reduces mitochondrial oxidative phosphorylation in hepatocytes and lowers energy production (6,18,22,32).…”

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confidence: 99%

Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection?

Golriz

Abbasi

Fathi

et al. 2017

American Journal of Physiology-Gastrointestinal and Liver Physi

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Small for size and flow syndrome (SFSF) is one of the most challenging complications following extended hepatectomy (EH). After EH, hepatic artery flow decreases and portal vein flow increases per 100 g of remnant liver volume (RLV). This causes hypoxia followed by metabolic acidosis. A correlation between acidosis and posthepatectomy liver failure has been postulated but not studied systematically in a large animal model or clinical setting. In our study, we performed stepwise liver resections on nine pigs to defined SFSF limits as follows: step 1: segment II/III resection, step 2: segment IV resection, step 3: segment V/VIII resection (RLV: 75, 50, and 25%, respectively). Blood gas values were measured before and after each step using four catheters inserted into the carotid artery, internal jugular vein, hepatic artery, and portal vein. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. EH correlated with reduced BE in the hepatic artery. Pco values increased after 75% resection in the jugular vein. In contrast, arterial Po increased after every resection, whereas the venous Po decreased slightly. There were differences in venous [Formula: see text], BE in the hepatic artery, and Pco in the jugular vein after 75% liver resection. Because 75% resection is the limit for SFSF, these noninvasive blood evaluations may be used to predict SFSF. Further studies with long-term follow-up are required to validate this correlation. This is the first study to evaluate acid-base parameters in major central and hepatic vessels during stepwise liver resection. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. Extended hepatectomy correlated with reduced BE in the hepatic artery. Because 75% resection is the limit for small for size and flow syndrome (SFSF), postresection blood gas evaluations may be used to predict SFSF.

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Equilibre acido-basique et exclusion vasculaire du foie : étude de 30 hépatectomies étendues

Cited by 2 publications

References 14 publications

Vascular clamping in liver surgery: physiology, indications and techniques

Vascular clamping in liver surgery: physiology, indications and techniques

Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection?

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