KARACÝÐER REZEKSÝYONU ESNASINDA SÜREKLÝ ÝSKEMÝ - REPERFÜZYON HASARI VE PROSTAGLANDÝN E2'NÝN ROLÜ

Majör karaciðer cerrahisinde özellikle karaciðer yaralanmalarý ve karaciðer tümörlerinde per-operatif kan kaybý hem hastanýn mortalitesi hem de morbiditesi açýsýndan önemlidir. Kansýz bir alan insanlarda Pringle manevrasý ile saðlanýr. Pringle manevrasý potansiyel olarak tehlikeli hepatik parankim iskemisine neden olur. Ýskeminin zararlý etkileri iskemi sýrasýnda oluþmakla birlikte, daha büyük hasarýn reperfüzyon sonrasýnda geliþtiði gösterilmiþtir (6-8). Bu çalýþmada karaciðer rezeksiyonu esnasýnda geride kalan karaciðer dokusunda iskemi reperfüzyon hasan karaciðer fonksiyon testleri, serbest oksijen radikalleri ile birlikte histolojik olarak incelendi ve prostaglandin E2'nin karaciðer iskemi-reperfüzyon hasarýný önlemekte yararlý olup olmadýðý araþtýrýldý. Çalýþma Haydarpaþa Numune Hastanesi Deney Hayvanlarý Araþtýrma Laboratuvarý'nda gerçekleþtirildi. Çalýþma 300-350 gr aðýrlýðýnda Albino-Wistar cinsi 24 erkek sýçanda yapýldý. 30 dakikalýk iskemiyi takiben % 70 hepatektomi gerçekleþtirildi. Karaciðer rezeksiyonunda sürekli iskemi ve reperfüzyon yapýlarak PGE2 nin etkisi araþtýrýldý. Karaciðer fonksiyon testlerinden ALT ve AST deðerleri post-op 1. gün hýzla yükseldi. Ý/R+PGE2 grubunda bu yükselme Ý/R grubuna göre çok daha azdý. AST ve ALT 7. gün hýzla normale döndü. Alkalen fosfataz yine Ý/R grubunda daha fazla yükseldi, 7. gün maksimum deðerine yükseldi, her iki grup arasýndaki anlamlý fark kapandý ve 21. gün düþme eðilimine girdi. Serum bilirubin düzeyleri yükselmekle birlikte her iki grup arasýnda anlamlý fark saptanmadý. Gama-GT düzeyleri her iki grupta da yükselmiþ, ancak Ý/R grubunda düþme daha yavaþ olmuþtur. Yine LDH düzeyleri Ý/R grubunda yüksek bulunmuþ, tüm gruplarda 7. ve 21. günlerde düþme eðilimi göstermiþtir. Sonuç olarak, karaciðer rezeksiyonu ile sürekli iskemi reperfüzyon modelinde PGE2 nin iskemi-repefüzyon hasarýný önlemede etkiliði olduðu, karaciðer fonksiyonlarýnýn erken dönemde bozulup hýzla düzeldiði, karaciðer kütlesinin 3 haftada eski düzeylerine yaklaþtýðý görüldü.

CONTINUOUS ISCHAEMIA AND REPERFUSION INJURY DURING LIVER RESECTION AND THE ROLE OF PROSTAGLANDIN E2

In major liver surgery especially in liver trauma and liver tumor, per-operative blood loss is important in patient's mortality and morbidity. A bloodless field is achieved by Pringle maneuver. Pringle maneuver causes potentially dangerous hepatic parenchymal ischemia. Although harmful effect of ischemia occurs during ischemia, it has been shown that much more harm occurs during reperfusion. In this study, ischemia reperfusion injury was examined by liver function tests, free oxygen radicals and with histologic examination in rest of liver tissue during liver resection and also PGE., was investigated if it is useful to prevent the liver ischemia reperfusion injury or not. This study was carried out at Haydarpaþa Teaching Hospital Experimental Animal Laboratory. 24 Albino Wistar male rats weighing 300-350 grs. were used f or the study. Following 30 minutes ischemic period 70 % hepatectomy was done and during liver resection the effect of PGE2 was investigated by doing ischemia and reperfusion. The levels of ALT and AST were rapidly elevated on the first day of post operative period. In IR + PGE2group this elevation was remarkably less if compared to IR group. ALT and AST levels rapidly turned to normal levels on the seventh day of post operative period. Alkaline Phosphatase was also elevated in IR group more and reached to maximum level on the seventh day. The significant difference between groups was disappeared and on the twenty first days declined. Serum bilirubin levels were elevated but there was no significant difference between two groups, gamma GT levels were elevated in both groups but the decrease observed in IR group was slower. Also LDH levels were higher in IR group and inclined to decrease on 7th and 21 st days. In conclusion, PGE2 is assessed to be useful to prevent ischemia reperfusion injury in liver resection. Liver function tests are bad in early period but rapidly become normal. It is seen that liver masses come to normal in three weeks.