Objective:To explore the protective effect of terlipressin on portal hyperperfusion syndrome in the early phase of posthepatectomy.
Methods :Thirty-six rats were randomly categorized into two groups for the study of hemodynamics of portal hyperperfusion injury after hepatectomy: 18 rats in Group Th (terlipressin treatment group for hemodynamics) and 18 rats in Group C (control group for hemodynamics). The hemodynamic parameters were detected before administration of terlipressin, and 30 min, 1 hour, and 2 hours after reperfusion. The Group T was subgrouped into subgroup Th1/2, Th1 and Th2 group in terms of different timepoints, and the Group Ch was also subgrouped into subgroup Ch1/2, Ch1 and Ch2 group respectively. Each subgroup consisted of 6 rats. Twenty rats were randomly categorized into two groups for survival study: 10 rats in Group Ts (Terlipressin group for survival) and 10 in Group Cs (control group for survival). All rats underwent major hepatectomy(90%) with Pringle maneuver for 30 minutes. Terlipressin was injected into the penile dorsal vein just before appliance of Pringle maneuver in rats of Group Th and Ts. The same amount of sterilized normal saline was injected at the same step in rats of Group Ch and Cs. The survival rate and hemodynamics of rats with small-for-size liver were studied.
Results:All rats survived more than 24 hours. The 10-day survival rate of Group Ts (80%) was significantly higher than that of Group Cs(P＜0.05). The portal pressure of subgroup Th1/2［（13.21±0.32）cm H2O）］was significantly lower than that of Subgroup Ch1/2［（16±1.03）cm H2O］(P＜0.05). The portal pressure reached its trough level［（11.52±0.17）cm H2O］ in subgroup Th1, which was significantly lower than that in subgroup Ch1［（13.5±0.18）cm H2O］(P＜0.05). The portal pressure of subgroup Ch1/2 was significantly higher compared to its corresponding basic portal pressure(P＜0.05). The portal blood flow of subgroup Th1/2［（7.21±0.21）mL/min］and Th1［（6.11±0.28）mL/min］was significantly lower than their corresponding subgroup Ch1/2［（9.50±0.35）mL/min］and Ch1［（6.99±0.19）mL/min］(P＜0.05). Meanwhile, the portal blood flow of subgroup Ch1/2 was significantly higher compared to its corresponding basic portal blood flow (P＜0.05). The mean blood pressure of subgroup Th1/2［（88.12±1.28）mmHg］, Th1［（80.83±1.79）mmHg］ and Th2［（76.29±0.89）mmHg］was significantly higher than that of subgroup Ch1/2［（57.97±2.01）mmHg］,Ch1［（59.86±1.75）mmHg］and Ch2［（63.71±1.37）mmHg］(P＜0.05). Meanwhile, the mean blood pressure of subgroup Th1/2, Th1 and Th2 was significantly higher than their corresponding basic mean blood pressure(P＜0.05). There was no significant difference of central venous pressure among all of the subgroups in Group Th and Group Ch. Also there was no significant difference of central venous pressure among all of the subgroups in each group compared to their corresponding basic central venous pressure.
Conclusions:Portal hyperperfusion state is transient in the early phase after major hepatectomy with reperfusion. Terlipressin ameliorates portal hyperperfusion injury by effectively reducing portal pressure and portal blood flow. The survival rate of rats with small-for-size liver after major hepatectomy can be significantly increased by administration of terlipressin.