Abstract:In the past, hepatic blood flow in cows was invasively characterized to investigate different pathologies and physiological conditions. However, hepatic blood flow can be easily evaluated with transabdominal Doppler ultrasound. Sixteen healthy adult non-lactating, non-pregnant Holstein-Friesian cows were examined using B-mode and Doppler ultrasound between the right flank and 9th intercostal space to establish the best approach to the different parts of the portal and hepatic vein systems, and determine normal… Show more
“…Total hepatic blood flow occlusion during surgical resection can completely block blood return to the portal vein system, resulting in gastrointestinal tract hyperemia, impaired mucosal barrier function, and high susceptibility to bacterial and toxin infections. Long-term blocking of portal blood flow can lead to portal vein and superior mesenteric vein thromboses[ 8 - 10 ]. More importantly, the blood entering the liver causes ischemic reperfusion injury of the liver parenchyma and distal organs after the blood flow is restored, and the liver function is seriously impaired.…”
BACKGROUND
Most patients with primary hepatocellular carcinoma (HCC) have a history of chronic hepatitis B and usually present with varying degrees of cirrhosis. Owing to the special nature of liver anatomy, the blood vessel wall in the liver parenchyma is thin and prone to bleeding. Heavy bleeding and blood transfusion during hepatectomy are independent risk factors for liver cancer recurrence and death. Various clinical methods have been used to reduce intraoperative bleeding, and the Pringle method is most widely used to prevent blood flow to the liver.
AIM
To investigate the effect of half-hepatic blood flow occlusion after patients with HCC and cirrhosis undergo hepatectomy.
METHODS
This retrospective study included 88 patients with HCC and liver cirrhosis who underwent hepatectomy in our hospital from January 2017 to September 2020. Patients were divided into two groups based on the following treatment methods: the research group (
n
= 44), treated with half-hepatic blood flow occlusion technology and the control group (
n
= 44), treated with total hepatic occlusion. Differences in operation procedure, blood transfusion, liver function, tumor markers, serum inflammatory response, and incidence of surgical complications were compared between the groups.
RESULTS
The operation lasted longer in the research group than in the control group (273.0 ± 24.8 min
vs
256.3 ± 28.5 min,
P
< 0.05), and the postoperative anal exhaust time was shorter in the research group than in the control group (50.0 ± 9.7 min
vs
55.1 ± 10.4 min,
P
< 0.05). There was no statistically significant difference in incision length, surgical bleeding, portal block time, drainage tube indwelling time, and hospital stay between the research and control groups (
P
> 0.05). Before surgery, there were no significant differences in serum alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin, and prealbumin levels between the research and control groups (
P
> 0.05). Conversely, 24 and 72 h after the operation the respective serum ALT (378.61 ± 77.49 U/L and 246.13 ± 54.06 U/L) and AST (355.30 ± 69.50 U/L and 223.47 ± 48.64 U/L) levels in the research group were significantly lower (
P
< 0.05) than those in the control group (ALT, 430.58 ± 83.67 U/L and 281.35 ± 59.61 U/L; AST, 416.49 ± 73.03 U/L and 248.62 ± 50.10 U/L). The operation complication rate did not significantly differ between the research group (15.91%) and the control group (22.73%;
P
> 0.05).
CONCLUSION
Half-hepatic blood flow occlusion technology is more beneficial than total hepatic occlusion in reducing liver function injury in hepatectomy for patients with HCC and...
“…Total hepatic blood flow occlusion during surgical resection can completely block blood return to the portal vein system, resulting in gastrointestinal tract hyperemia, impaired mucosal barrier function, and high susceptibility to bacterial and toxin infections. Long-term blocking of portal blood flow can lead to portal vein and superior mesenteric vein thromboses[ 8 - 10 ]. More importantly, the blood entering the liver causes ischemic reperfusion injury of the liver parenchyma and distal organs after the blood flow is restored, and the liver function is seriously impaired.…”
BACKGROUND
Most patients with primary hepatocellular carcinoma (HCC) have a history of chronic hepatitis B and usually present with varying degrees of cirrhosis. Owing to the special nature of liver anatomy, the blood vessel wall in the liver parenchyma is thin and prone to bleeding. Heavy bleeding and blood transfusion during hepatectomy are independent risk factors for liver cancer recurrence and death. Various clinical methods have been used to reduce intraoperative bleeding, and the Pringle method is most widely used to prevent blood flow to the liver.
AIM
To investigate the effect of half-hepatic blood flow occlusion after patients with HCC and cirrhosis undergo hepatectomy.
METHODS
This retrospective study included 88 patients with HCC and liver cirrhosis who underwent hepatectomy in our hospital from January 2017 to September 2020. Patients were divided into two groups based on the following treatment methods: the research group (
n
= 44), treated with half-hepatic blood flow occlusion technology and the control group (
n
= 44), treated with total hepatic occlusion. Differences in operation procedure, blood transfusion, liver function, tumor markers, serum inflammatory response, and incidence of surgical complications were compared between the groups.
RESULTS
The operation lasted longer in the research group than in the control group (273.0 ± 24.8 min
vs
256.3 ± 28.5 min,
P
< 0.05), and the postoperative anal exhaust time was shorter in the research group than in the control group (50.0 ± 9.7 min
vs
55.1 ± 10.4 min,
P
< 0.05). There was no statistically significant difference in incision length, surgical bleeding, portal block time, drainage tube indwelling time, and hospital stay between the research and control groups (
P
> 0.05). Before surgery, there were no significant differences in serum alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin, and prealbumin levels between the research and control groups (
P
> 0.05). Conversely, 24 and 72 h after the operation the respective serum ALT (378.61 ± 77.49 U/L and 246.13 ± 54.06 U/L) and AST (355.30 ± 69.50 U/L and 223.47 ± 48.64 U/L) levels in the research group were significantly lower (
P
< 0.05) than those in the control group (ALT, 430.58 ± 83.67 U/L and 281.35 ± 59.61 U/L; AST, 416.49 ± 73.03 U/L and 248.62 ± 50.10 U/L). The operation complication rate did not significantly differ between the research group (15.91%) and the control group (22.73%;
P
> 0.05).
CONCLUSION
Half-hepatic blood flow occlusion technology is more beneficial than total hepatic occlusion in reducing liver function injury in hepatectomy for patients with HCC and...
“…The observed Doppler waveform corresponded to a low resistance profile with continuous diastolic flow, but with a small spectral window, indicating a higher velocity profile than more distal arteries [ 11 ]. Some turbulence was also detected in the Doppler profile of the renal artery and its main tributaries, which was partly explained by the large size of the vessel, which increased the Reynolds number, and some tortuosity extending from the aorta to the renal artery, as described for the portal system [ 31 ].…”
Section: Discussionmentioning
confidence: 99%
“…As part of a general study of the normal abdominal ultrasound examination in adult cows, a transcutaneous abdominal ultrasound exploration of the right abdomen was performed, from caudal to cranial, as previously described [ 7 , 31 ]. The ultrasound examination was conducted while the animals were standing in stocks without sedation.…”
Section: Methodsmentioning
confidence: 99%
“…All examinations were performed between 17:00 and 19:00, always by the same operator (J.D.B.-V.). The right abdominal skin was routinely prepared for ultrasonography, as previously described [ 31 , 32 ]. Alcohol and ultrasound gel were applied to optimize ultrasound probe contact with the animal´s skin.…”
There is a notable lack of reference values for the renal resistive indices in the bovine kidney. Ultrasound (US) Doppler evaluation of these indices is a powerful, non-invasive technique for assessing, monitoring and diagnosing renal diseases in humans and other animals (e.g., small animals and horses). The aims of the present study were to establish a protocol for renal Doppler US in adult healthy Holstein-Friesian cows and to provide reference values for the renal resistive index (RI) and pulsatility index (PI). In cattle, the right kidney is always visible through a right abdominal window. Nevertheless, the left kidney is rarely accessible by transabdominal ultrasound. Doppler evaluation of the kidneys via a transabdominal approach is possible when accessible, but measurements can only be made in the larger vessels at the renal hilum. Normal RI and PI values were respectively 0.49 ± 0.07 and 0.70 ± 0.15 for the right kidney and 0.53 ± 0.05 and 0.79 ± 0.11 for the left kidney. We suggest an upper cut-off value for the RI of 0.63 and for the PI of 1.00 in healthy Holstein-Friesian cows. This is the first report describing normal values for the renal RI and PI in cattle that may be useful in future studies for characterizing different bovine pathologies that affect the renal parenchyma.
“…As part of a general study of the normal abdominal ultrasound examination in adult cows, a transcutaneous abdominal ultrasound exploration of the right abdomen was performed, from caudal to cranial, as previously described [1,28]. A dorsal approach to the left abdomen was also included, to verify accessibility to the adrenal glands.…”
Ultrasonographic reference values for the adrenal glands of cattle have not been reported to date. Adrenal glands can be affected by different pathologies, such as hyperplasia, neoplasia and atrophy (either primary or secondary). The present findings indicate that the right adrenal gland can be easily characterized by transabdominal ultrasound in adult Holstein–Friesian cows, with no apparent influence of age or weight. The right adrenal gland (mean length 3.86 ± 1.39 cm; and mean thickness 1.39 ± 0.26 cm) was consistently and mainly located in the 12th intercostal space. The left adrenal gland was more difficult to locate due to its more medial position, and to the presence of gas in the gastrointestinal tract, so it could not be visualized in most animals (18/25). Its mean length was 3.72 ± 0.95 cm, and mean thickness was 1.36 ± 0.33 cm, in the sagittal section. This is the first report of the ultrasonographic appearance of the adrenal glands of cows and of the corresponding reference preliminary values.
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