Hepatoduodenal ligament is occasionally temporary occluded in the major hepatic resection to minimize bleeing. Huguet et al. reported that a 65 min of its occlusion was tolerated well in the patient with hepatoma. However, many hepatic tumors were coexisted with cirrhosis. Even now, there was no study about the tolerance of temporary occlusion of afferent vessels in the compensatory cirrhotic liver.
I therefore studied this problems in the following experiment and results were as follows:
1. As control group, hepatoduodenal ligament was temporary occluded in 106 untreated SD-rats (for 10 min 10 animals, 20 min 10, 30 min 10, 40 min 20, 50 min 20 and 60 min 20). All animals survived the clamping of 40 min, but in the 50 min occlusion 4 of 20 animals, in the 60 min 9 of 20 animals could not survive one week. Furthermore, 12 h after 10, 20, 30, 40, 50 and 60 min occlusion, every 8 survived rats were sacrified to estimate the biochemical studies. I found in this experiment 3 stages of warm ischernic liver damage, i.e. first stage of minimal hepatic damage during 0-20 min ischemia, second stage of intermediated hepatic damage after 30-40 min ischemia and third stage of severe hepatic damage in the ischemia of 50 rein and more (AST value more than 1500U/I). This results suggest that the riskless occlusion time is less than 40 min in non cirrhotic livers.
2. In 266 untreated SD-rats, intermittent occlusion of hepatoduodenal ligament (in 102 animals 10 min free circulation was followed after 20 min occlusion and in 164 animals 10 min occlusion and 10 min recirculation) were performed. By these procedure the riskless tolerance time of occlusion could prolong until 60-80 min.
3. The compensatory liver cirrhosis was induced by 6 weeks application of M, (0.1 ml/1008 B.W.) twice weekly and every 7 animals were occluded the hepatoduodenal ligament for 10, 20, 30 and 40 min. Furthermore, in every 7 rats studied the liver enzyme in sera 12 h after recirculation of afferent hepatic vessels. All animals could survive 0-30 min of ischemia, however, not 40 min. Because of the cirrhotic damage, we observed the high level of hepatic enzyme despite of 0-30 min ischemia (AST-values more than 2000U1I). In rats with cirrhosis we performed an intermittent occlusion of hepatoduodenal ligament and examined survival and liver enzyme levels. Despite of these procedure the animals could tolerate only total occlusion, time of 30 min, however, the enzyme studies showed less hepatic damage in (:,orn. paring to the 30 min continuous occlusion.
4. In 260 untreated animals with 70% hepatecton-1y, the tolerance of henatic ischell, a
was relatively similar as compared with the rats without hepatectomy. Therefore,
the safe period of the hepatic ischemic tolerance does not seemed to be atributed
to the rest volume of the liver tissue after partial hepatectomy in nomal liver.
5. In 148 rats with cirrhosis 70% hepatectomy was performed. 5 of 6 animals could
survive and only 4 of 7 additional 10 min occlusion of hepatoduodenal ligament.
Summarized: l) Despite of numerous species differences in the hepatic ischemic tolerance, It has been supposed that the maximum tolerable time by the occlusion of hepatoduodenal ligament were related about 40 min in normal liver. 2) In the warns ischemia of the liver, there are 3 stages of damage. 3) Independent on the continuous or intermittent procedure, the riskless occlusion time of afferent hepatic vessels in compensatory cirrhotic liver resection is less than 30 min and in normal liver it can
F,it T be prolonged 40-80 min. 4) The compensatory cirrhotic liver can not riskless tolerate
i the 70% hepatectomy alone.
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