The Effect of Temporary Portocaval Shunt in Liver Resection Under Portal Triad Clamping

Ra, H D; Kim, Y I; Hwang, Y J; Yun, Y K

Abstract

BACKGROUND: Hepatectomy under prolonged inflow occlusion in compromised liver is an acceptable procedure, despites of ischemic liver injury. However, the effect of abdominal visceral stagnation during the occlusion periods was not fully investigated. We examined the effectiveness of the temporary portal decompression during prolonged hepatic inflow occlusion.
METHODS
20 patients who underwent hepatectomy under the continuous inflow occlusion were divided into two groups according to the with(Group I) or without(Group II) temporary portosystemic shunt.(n=10, respectively) Temporary portosystemic shunt was built between portal vein tributarity in the mesentery and infrahepatic inferior vena cava by inserting the heparin-bonded Anthrone tube. In order to estimate the intestinal stress, we measured cytokine(IL-6) levels in the portal venous blood and the systemic blood at preclamping, before and 1hour after declamping. Also we measured ICGR15, routine liver fuction tests, coagulation parameters and portal vein pressure of the two groups.
RESULTS
The duration of hepatic inflow occlusion(HIO) and the increase of portal vein pressure during HIO showed a trend of correlation with the level of IL-6 during HIO.
CONCLUSION
These data indicates that the production of IL-6 in the portal circulation is closely related to the hepatocyte injury in ischemia/reperfusion of the liver and the congestion of bowel. The temporary portosystemic shunt during HIO seems to be a useful maneuver, especially when the portal pressure increased significantly during HIO.