J.Jpn. Surg. Soc.. 90(6): 837-846, 1989

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Original article

THE EFFECT OF PORTO-INTRAHEPATIC PORTAL BYPASS ON THE ISCHEMIC LIVER DURING CLAMPING THE HEPATIC INFLOW

The object of this study was to determine the critical bypass fiow rate of the porto-intrahepatic portal bypass during clamping the hepatic inflow, and to clarify the pathophysiology caused by this bypass procedure with special emphasis on the hepatic injury.
Porto-intrahepatic portal bypass was instituted, using anti-thrombogenic catheter (Anthron^Ⓡ), during clamping the hepatic inflow in anesthetized dogs. Bypass flow rate (BFR) was controlled at 10％, 30％ and 60％ of the portal flow in the individual experimental groups. As the control study, double bypass (portosystemic and femoral arterio-intrahepaic portol bypass) or portal-systemic bypass was instituted during clamping the hepatic inflow, and porto-systemic bypass at 10％ and 60％ during clamping the portal vein. Total adenine nucleotide (TAN) and adenylate energy charge (EC) of the liver did not chonge during 2 hour clamp of the portal vein. Clamping the hepatic inflow, unless congested splanchnic circulation, demonstrated the same level as 30％ porto-portal bypass.
Taking changes in hemodynamis, portal into consideration and arterial pH and PO₂ levels, serum transaminase levels, ICG retention rate and animal survival rate, we conclude that insuffcient flow rate of porto-portal bypass (10％, 30％) even cause more severe hepatic damage, and critical flow rate must be between 30％ and 60％ during 1 hour clamp.

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