中文(简体)
Albanian
Arabic
Armenian
Azerbaijani
Belarusian
Bengali
Bosnian
Catalan
Czech
Danish
Deutsch
Dutch
English
Estonian
Finnish
Français
Greek
Haitian Creole
Hebrew
Hindi
Hungarian
Icelandic
Indonesian
Irish
Italian
Japanese
Korean
Latvian
Lithuanian
Macedonian
Mongolian
Norwegian
Persian
Polish
Portuguese
Romanian
Russian
Serbian
Slovak
Slovenian
Spanish
Swahili
Swedish
Turkish
Ukrainian
Vietnamese
Български
中文(简体)
中文(繁體)

Ischemic Preconditioning at a Distance in Liver Surgery

只有注册用户可以翻译文章
登陆注册
链接已保存到剪贴板
状态尚未招聘
赞助商
University Hospital, Lille

关键词

抽象

During hepatic transection, it exists a high risk of perioperative blood loss. The haemorrhage and its consequences (hypovolemia and blood transfusion) might impact the short and long term morbidity The vascular control by hepatic pedicle clamping (Pringle's maneuver) or total hepatic vascular exclusion, helps minimizing blood loss and leads to a more extensive hepatic resection.
Side effects of vascular control result of ischemia-reperfusion injury (IRI) : these reperfusion lesions results of different mechanisms than those responsible for the ischemic one. IRI cause lesions and postoperative dysfunction of the remaining liver.
Among strategies to reduce the adverse effects of IRI : ischaemic preconditioning (IPC) has been described. It can be either mechanical (intermittent hepatic pedicle clamping) or pharmacological (sevoflurane inhalation).
Short intermittent vascular occlusions in a organ might produce a resistance to a longer ischaemic period. It is certainly a physiological organ adaptation to tissue hypoxemia, which has a therapeutic potential when targeted.
During liver resection, ischaemic preconditioning is realised with periods of hepatic pedicle clamping and unclamping. It decrease morbidity and mortality and prevent postoperative hepatocellular insufficiency due to clamping and IRI at day 5.
Ischaemic preconditioning may also be applied remotely. Indeed, it is shown that short ischaemic periods in a target organ can also have a protective effect on distant others. This mechanism involve three signalling pathways : neuronal , humoral and systemic pathways.
In a previous randomized study, Kanoria and al, demonstrated that the remote ischaemic preconditioning group has shown significant lower rates of serum transaminases and higher liver clearance (spectrophotometry method) than the control group.
A latest study, measuring postoperative prothrombin rates has shown improved liver recovery due to halogen agents such as sevoflurane.

日期

最后验证: 10/31/2019
首次提交: 11/19/2019
提交的预估入学人数: 11/26/2019
首次发布: 11/28/2019
上次提交的更新: 11/26/2019
最近更新发布: 11/28/2019
实际学习开始日期: 01/31/2020
预计主要完成日期: 01/31/2021
预计完成日期: 01/31/2021

状况或疾病

Liver Diseases

干预/治疗

Procedure: Inflation of a pneumatic tourniquet

Other: No inflation

-

手臂组

干预/治疗
Experimental: Inflation of a pneumatic tourniquet
Procedure: Inflation of a pneumatic tourniquet
a pneumatic tourniquet around 200 mmHg after venous chase of the lower limb, during 5 minutes then deflated. Repeated twice after general anaesthesia and prior to incision.
Sham Comparator: No inflation
No inflation of the pneumatic tourniquet placed on the lower limb
Other: No inflation
No inflation of the pneumatic tourniquet placed on the lower limb

资格标准

有资格学习的年龄 18 Years 至 18 Years
有资格学习的性别All
接受健康志愿者
标准

Inclusion Criteria:

- Scheduled carcinogenic laparoscopy or laparotomy liver resection

- Insured under the social security system

- Inclined to comply to the study protocol and its duration.

Exclusion Criteria:

- Patient under guardianship

- Pregnancy or breastfeeding

- Severe lower limb vascular disease

- Emergency surgery

- Contraindication of a treatment from the protocol

- Psychological disorder with difficulty to accede the protocol

- Absence of written informed consent

- Refusal to sign the protocol

- Non-registration to the social security system

结果

主要结果指标

1. Indocyanine green clearance [at 5 days after liver resection]

Indocyanine green clearance (%/min) by indocyanine green retention, measured with Limon pulse spectrophotometry method.

次要成果指标

1. Serum transaminases rates [at day 1,day 3 and day 5 post-hepatectomy.]

2. Prothrombin rate [at day 5 post-hepatectomy.]

3. the Kidney Disease: Improving Global Outcomes (KDIGO) score [at day 1,day 3 and day 5 post-hepatectomy.]

The score varies from 1 to 4.

4. the Clavien & Dindo score [at day 30 post-hepatectomy]

this classification in order to rank a post operative complications. It consists of 7 grades (I, II, IIIa, IIIb, IVa, IVb and V)

5. duration of stay in the hospital. [at day 30 post-hepatectomy]

加入我们的脸书专页

科学支持的最完整的草药数据库

  • 支持55种语言
  • 科学支持的草药疗法
  • 通过图像识别草药
  • 交互式GPS地图-在位置标记草药(即将推出)
  • 阅读与您的搜索相关的科学出版物
  • 通过药效搜索药草
  • 组织您的兴趣并及时了解新闻研究,临床试验和专利

输入症状或疾病,并阅读可能有用的草药,输入草药并查看所使用的疾病和症状。
*所有信息均基于已发表的科学研究

Google Play badgeApp Store badge