Potenzierung des tempor�ren, isch�misch bedingten Leberschadens durch eine Lymphabflu�blockade

Abstract

In order to determine the influence of complete blockage of lymph flow on temporary ischemic liver damage, we operated on 46 mongrel dogs. In group 1, we induced liver ischemia in 4 dogs for 60 min by occlusion of the afferent hepatic vessels (hepatic artery and portal vein), subsequent to portal decompression by a portocaval H-shunt. In group2, we carried out an additional lymph flow blockage by dissection of all connective tissue from the liver in 4 dogs. As only one dog survived in group 2, further experiments were performed with 45-min ischemia. In groups 3 and 4, we induced 45-min ischemia with subsequent biochemical and histological studies, respectively, for 5 weeks postoperatively in a total of 20 dogs. Groups 5 and 6 were treated like groups 3 and 4, but with additional blockage of lymph flow. In groups 3 and 4, no animals died, whereas 4 of 18 dogs died in groups 5 and 6. We found much higher levels of enzymes (GOT up to 1124.8 + 560.9; GPT up to 1139.9 + 475.8 and alkaline phosphatase up to 896.8 + 264.8mU/ml) in group5 than in group3 (GOT up to 88.7+26.9; GPT up to 94.8+27.4 and alkaline phosphatase up to 60.9 + 10.8 mU/ml). In group 3, values returned to normal 3-5 days after surgery compared to 3 weeks and longer in group 5. Besides necrosis and cell infiltrations the histological studies showed edematous changes and a lymphostatic hemangiopathy. The histological damage corresponded to the biochemical changes. It was concluded that additional blockage of lymph flow leads to potential ischemic liver damage.