Περίληψη:
Hepatectomies performed under selective hepatic vascular exclusion are
associated with a series of events culminating in ischemia/reperfusion
injury, a state that shares common characteristics with situations known
to result in global or regional hyperlactatemia. Accordingly, we sought
to determine whether lactate is released by the liver during hepatic
resections performed under blood flow deprivation and what relation this
has to a possible systemic hyperlactatemic state. After ethical
approval, 14 consecutive patients with resectable liver tumors subjected
to hepatectomy under inflow and outflow occlusion of the liver were
studied. Lactate concentrations were assessed in simultaneously drawn
arterial, portal venous, and hepatic venous blood before liver
dissection and 50 minutes postreperfusion. Moreover, the transhepatic
lactate gradient (hepatic vein - portal vein) was calculated to see if
there was net production or consumption of lactate. Before hepatic
dissection, the transhepatic lactate gradient was negative, suggesting
consumption by the liver. Fifty minutes after reperfusion, this gradient
became significantly positive, demonstrating release of lactate by the
liver (0.12 +/- 0.31 vs. -0.38 +/- 0.30 mmol/L, P < 0.05). The magnitude
of lactate release correlated with systemic arterial lactate levels at
the same time point (r(2) = 0.63, P < 0.001). A weaker but significant
correlation was demonstrated between the transhepatic lactate gradient
postreperfusion and systemic arterial lactate levels 24 hours
postoperatively (r(2) = 0.41, P = 0.013). A strong correlation between
the transhepatic lactate gradient postreperfusion and peak postoperative
aspartate aminotransferase values was also demonstrated (r(2) = 0.73, P
< 0.001). The liver becomes a net producer of lactate in hepatectomies
performed under blood flow deprivation. This lactate release can explain
some of the systemic hyperlactatemia seen in this context and relates to
the extent of ischemia/reperfusion injury.
Συγγραφείς:
Theodoraki, Kassiani
Arkadopoulos, Nikolaos
Fragulidis, George
and Voros, Dionysios
Karapanos, Konstantinos
Markatou, Maria and
Kostopanagiotou, Georgia
Smyrniotis, Vassilios
