PRELIMINARY DATA ON INTERMITTENT PRELIMINARY DATA ON INTERMITTENT PRINGLE (BARON) PRINGLE (BARON) MANOEUVREMANOEUVRE IN IN
A CANINE MODELA CANINE MODELGÁBOR ÁCS, NORBERT NÉMETH, ANDREA FURKA*,
JÓZSEF PAP-SZEKERES**, ADRIENN GULYÁS,JUDIT ZSÓTÉR, ISTVÁN FURKA, IRÉN MIKÓ
Department of Operative Techniques and Surgical Research,*2nd Department of Surgery University of Debrecen, Hungary
**Department of Surgery, County Hospital Kecskemét, Hungary
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
INTRODUCTIONcompression of the hepato-duodenal ligamenttrauma (seat belt, air bag) reconstructive operation of livernon traumatic liver resection
Pringle (Baron) manoeuvre
inflow occlusionhepatic ischaemiain collecting area of the portal vein stasisischaemia-reperfusion injurylocal and systemic effect
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
BACKGROUNDinput side: portal vein-hepatic artery outflow way: hepatic vein system-lymphatic system
indirect portal compressionincreased intraabdominal pressure(external compression, gravidity,blunt abdominal trauma,high pressure laparoscopic surgery,ascites)
direct occlusion of portal triadlocal pathological alterations, surgical interventions
target of the portal compression is not only the liver ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG
27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
MATERIALS AND METHODS I.Permission:
Committee of Animal Researchat University of Debrecen(N°11/2003)
Animals:5 mongrel dogs,12-15 kg (14.2 ± 2.38 kg) body weight2-4 weeks of observationveterinary care, mixed food,had free access to water, individual cages
Anaesthesia:ketamin (10 mg/kg)+xylasin hydrochloride (0.1 mg/kg)i.m., repeated in all 20 minutes with half dose
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
MATERIALS AND METHODS II.Operation:
left external jugular vein(V), left femoral artery(A) cannulation
midline laparotomyhepatic vein (H) system cannulatation via inferior caval
veinportal vein (P) cannulation via a mesenteric veinPringle (Baron) manoeuvres (PM) with atraumatic
clampsischaemia periods: 3 times, 10-10 minutesreperfusion periods: (RP) 5-5 minutes
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
MATERIALS AND METHODS III.
blood samples for haematological test: femoral artery (A), portal vein (P),
hepatic vein (H), external jugular vein (V)
blood samples forcoagulation, haemorheological and chemical tests:
external jugular vein (V)
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
1st PM 2nd PM1st RP 2nd RP 3rd PM
10 min 5 min 10 min10 min 5 min
MATERIALS AND METHODS IV.
blood tests:Sysmex F-800 microcell counter, Sysmex CA-500
automated coagulometer(TOA Medical Electronics Co. Ltd., Japan)
Hevimet-40 capillary viscosimeter (Hemorhex Ltd., Hungary)
FT-1 filtrometer (Carat Diagnostic Ltd., Hungary)
statistical analysis: SigmaStat (Jandel Scientific Co., Germany)
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
1st PM 2nd PM1st RP 2nd RP 3rd PM
10 min 5 min 10 min10 min 5 min
RESULTS
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
Red blood cell count [RBC] changes after Pringle (Baron) manoeuvres [PM] and reperfusion periods [RP] in blood samples
from different points of circulation (* p<0.05 )
6,0
7,0
8,0
9,0
FEMORALARTERY
PORTALVEIN
HEPATICVEIN
JUGULARVEIN
RB
C[T
/L] +
/- S.
D.
Base 1st PM 1st RP 2nd PM 2nd RP 3rd PM
*
*
** **
Haematocrit value [HCT] changes after Pringle (Baron) manoeuvres [PM] and reperfusion periods [RP] in blood samples
from different points of circulation ( *p<0.05 )
35,0
40,0
45,0
50,0
55,0
60,0
65,0
0 5 10 15 20 25 30 35 40TIME [minutes]
HC
T [%
] +/-
S.D
.
FEMORAL ARTERY PORTAL VEIN HEPATIC VEIN JUGULAR VEIN
1st PM 2nd PM 3rd PM1st RP 2nd RP
** * **
White blood cell count [WBC] changes after Pringle (Baron) manoeuvres [PM] and reperfusion periods [RP] in blood samples
from different points of circulation ( * p<0.05 )
2,5
5,0
7,5
10,0
12,5
15,0
0 5 10 15 20 25 30 35 40TIME [minutes]
WBC
[G/L
] +/-
S.D.
FEMORAL ARTERY PORTAL VEIN HEPATIC VEIN JUGULAR VEIN
1st PM 2nd PM 3rd PM1st RP 2nd RP
*
***
White blood cell count trend [WBC50] changes standardised to 50% haematocrit after Pringle (Baron) manoeuvres [PM] and
reperfusion periods [RP] in blood samples from different points of circulation
5,0
7,5
10,0
FEMORAL ARTERY PORTAL VEIN HEPATIC VEIN JUGULAR VEIN
WB
C50
[G/L
](HC
T=50
%)
Base 1st PM 1st RP 2nd PM 2nd RP 3rd PM
CONCLUSIONAfter three time 10 minutes long
Pringle (Baron) manoeuvre we found significant changes
in systemic and localhaematological and haemostasis
parameters.
This experimentalhepatic ischaemia model
is useable for further researchto reduce the harmful
consequencesof liver injury and temporary
inflow occlusion.
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH
Thank you !
ÖSTERREICHISCHE GESELLSCHAFT FÜR CHIRURGISCHE FORSCHUNG27. SEMINAR 3.-5. DEZEMBER 2003, GOSAU, ÖSTERREICH