Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1...Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1,2020 to July 31,2021,80 patients were enrolled,including 40 undergoing intraperitoneal Pringle maneuver(IPM)and 40 extraperitoneal Pringle maneuver(EPM).The observation indices included basic preoperative clinical characteristics and intraoperative and postoperative liver function indices.Results:There were no significant differences in the basic characteristics or types of hepatectomy,intraoperative blood loss,intraoperative blood transfusion,or hepatectomy time between the IPM and EPM groups.However,the blocking and operation time in the IPM group was shorter than that in the EPM group.There were no significant differences in alanine aminotransferase(ALT)or aspartate aminotransferase(AST)levels on the first day after surgery or in total bilirubin(TBIL)or albumin(ALB)levels on the first,third,or fifth days after surgery.However,C-reactive protein(CRP)levels on the first and third days,ALT and AST levels on the third and fifth days were lower,and hospital stay after surgery was shorter in the IPM group than in the EPM group.Conclusion:IPM using bulldog clamps is simple,safe,and effective.The inflammatory reaction is less severe,the degree of liver function injury is lower,and recovery is faster.展开更多
AIM:To investigate the protective effect of erythropoietin (Epo) against ischemia-reperfusion injury (IR/I) following the Pringle maneuver (PM),in comparison with conventional steroid administration in a prospective r...AIM:To investigate the protective effect of erythropoietin (Epo) against ischemia-reperfusion injury (IR/I) following the Pringle maneuver (PM),in comparison with conventional steroid administration in a prospective randomized trial. METHODS:Patients were randomized by age, sex, diagnosis, and surgical method, and assigned to three groups:(1) A steroid group (STRD, n= 9) who received 100 mg of hydrocortisone before PM, and on postoperative days 1, 2 and 3, followed by tapering until postoperative day 7; (2) An EPO1 group (n=10) who received 30 000 U of Epo before the PM and at the end of surgery; and (3) An EPO2 group (n=8) who received 60 000 U of Epo before the PM. Hemoglobin (Hb), hematocrit (Ht), aspartate aminotransferase (AST), alanine transaminase (ALT),lactate dehydrogenase (LDH), lactate, interleukin-6 (IL-6),and tumor necrosis factor(TNF)-α were measured before and just after (Day 0) surgery, and on postoperative days 1, 3, 7 and 14. RESULTS: There were no increases in Hb and Ht in the EPO1 and EPO2 groups. AST was signif icantly lower in EPO1 than in STRD on Day 0 (P=0.041), and lower in EPO1 than in STRD and EPO2 on Day 1 (P=0.018). ALT was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.020) and Day 1 (P=0.004). There were no signif icant inter-group differences in the levels of LDH and lactate. IL-6 was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.0036) and Day 1 (P=0.0451). TNF-α was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.0006) and Day 1 (P<0.0001). Furthermore, hospitalization was signif icantly shorter in EPO1 and EPO2 than in STRD.CONCLUSION:Epo has greater potential than steroids to ameliorate IR/I after the PM. Epo at a dose of 30000 U, administered before PM and just after surgery, yields better results.展开更多
基金supported by grants from Scientific Research Fund of Anhui Medical University(No.2021xkj034)Clinical Research Cultivation Program of the Second Affiliated Hospital of Anhui Medical University(No.2020LCYB18)Anhui Institute of Translational Medicine(No.2023zhyx-C84).
文摘Objective:This prospective randomized controlled study was conducted to evaluate the safety and efficacy of the Pringle hepatic hilar occlusion with a bulldog clamp in laparoscopic liver resection.Methods:From March 1,2020 to July 31,2021,80 patients were enrolled,including 40 undergoing intraperitoneal Pringle maneuver(IPM)and 40 extraperitoneal Pringle maneuver(EPM).The observation indices included basic preoperative clinical characteristics and intraoperative and postoperative liver function indices.Results:There were no significant differences in the basic characteristics or types of hepatectomy,intraoperative blood loss,intraoperative blood transfusion,or hepatectomy time between the IPM and EPM groups.However,the blocking and operation time in the IPM group was shorter than that in the EPM group.There were no significant differences in alanine aminotransferase(ALT)or aspartate aminotransferase(AST)levels on the first day after surgery or in total bilirubin(TBIL)or albumin(ALB)levels on the first,third,or fifth days after surgery.However,C-reactive protein(CRP)levels on the first and third days,ALT and AST levels on the third and fifth days were lower,and hospital stay after surgery was shorter in the IPM group than in the EPM group.Conclusion:IPM using bulldog clamps is simple,safe,and effective.The inflammatory reaction is less severe,the degree of liver function injury is lower,and recovery is faster.
基金Supported by (partly) A Research Grant from the Biomarker Society,Japan
文摘AIM:To investigate the protective effect of erythropoietin (Epo) against ischemia-reperfusion injury (IR/I) following the Pringle maneuver (PM),in comparison with conventional steroid administration in a prospective randomized trial. METHODS:Patients were randomized by age, sex, diagnosis, and surgical method, and assigned to three groups:(1) A steroid group (STRD, n= 9) who received 100 mg of hydrocortisone before PM, and on postoperative days 1, 2 and 3, followed by tapering until postoperative day 7; (2) An EPO1 group (n=10) who received 30 000 U of Epo before the PM and at the end of surgery; and (3) An EPO2 group (n=8) who received 60 000 U of Epo before the PM. Hemoglobin (Hb), hematocrit (Ht), aspartate aminotransferase (AST), alanine transaminase (ALT),lactate dehydrogenase (LDH), lactate, interleukin-6 (IL-6),and tumor necrosis factor(TNF)-α were measured before and just after (Day 0) surgery, and on postoperative days 1, 3, 7 and 14. RESULTS: There were no increases in Hb and Ht in the EPO1 and EPO2 groups. AST was signif icantly lower in EPO1 than in STRD on Day 0 (P=0.041), and lower in EPO1 than in STRD and EPO2 on Day 1 (P=0.018). ALT was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.020) and Day 1 (P=0.004). There were no signif icant inter-group differences in the levels of LDH and lactate. IL-6 was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.0036) and Day 1 (P=0.0451). TNF-α was signif icantly lower in EPO1 than in STRD and EPO2 on Day 0 (P=0.0006) and Day 1 (P<0.0001). Furthermore, hospitalization was signif icantly shorter in EPO1 and EPO2 than in STRD.CONCLUSION:Epo has greater potential than steroids to ameliorate IR/I after the PM. Epo at a dose of 30000 U, administered before PM and just after surgery, yields better results.
