Until now, a direct comparison of the effects of three techniques for hepatic vascular inflow occlusion during resection for liver cirrhosis including the Pringle maneuver , hemihepatic vascular occlusion, and hepatic blood inflow occlusion without hemihepatic artery control on I/R injury and the underlying molecular mechanisms has not been well studied.
Next, the rats with liver cirrhosis were subjected to three different techniques for hepatic vascular exclusion of liver surgery: Pringle maneuver in the PR group, hemihepatic vascular occlusion in the HH group, or hepatic blood inflow occlusion without hemihepatic artery control in the WH group.
The morphology examination and the results of the liver enzyme ALT/AST tests indicated that hemihepatic vascular occlusion and hepatic blood inflow occlusion without hemihepatic artery control showed similar capability of reducing the hepatic I/R injury, but were better than the Pringle maneuver.
As shown in Figures 5 and 6, at each time point, TLR4 and TRIF expression levels in the WH and HH groups were significantly lower than those in the PR group (P < 0.05), while the differences between the WH and HH groups were not statistically significant, suggesting that less prominent activation of the TLR4/TRIF transduction pathway may contribute to the reduced hepatic I/R injury that occurred in the two groups of blood inflow occlusion without hemihepatic artery control and hemihepatic vascular occlusion compared with the Pringle maneuver group.
In the this study, we directly compared the benefits and harms of the three different surgical techniques for hepatic vascular exclusion, the Pringle maneuver, hemihepatic vascular occlusion, and hepatic blood inflow occlusion without hemihepatic artery control, during resection in the cirrhotic liver and their underlying molecular mechanisms using a rat model of liver cirrhosis.
More insightful studies are needed to identify the molecular mechanisms that are responsible for the important outcomes of hemihepatic vascular occlusion and hepatic blood inflow occlusion without hemihepatic artery control during resection compared with the Pringle maneuver in rats.
Pringle Maneuver. The hepatic pedicle was encircled with a vascular tape for possible temporary inflow control of the liver.
Pringle maneuver was adopted in six cases for temporary inflow control of the liver (occlusion time ranged from 6 min to 13 min).
A broken hepatic vein is repaired more conveniently after the caudate lobe is moved out as it is facilitated by Pringle maneuver. If combined with occlusion of the confluence of the left and middle hepatic veins (and sometimes the right hepatic vein), a more clear operative field is presented with less possibility of air embolism.