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Randomized Analysis of Surgical Parameters

Keiichi Kubota, MD, PhD; Masatoshi Makuuchi, MD, PhD; Tamaki Noie, MD; Koji Kusaka, MD; Yoshihiro Sakamoto, MD; Kenji Miki, MD; Yasushi Harihara, MD, PhD; Tadatoshi Takayama, MD, PhD

Arch Surg. 1998;133:303-308.

Objectives  To determine whether the increased portal venous pressure caused by use of the Pringle maneuver contributes to inducing posthepatectomy hyperamylasemia and, subsequently, to evaluate risk factors for its development.

Design  Randomized study.

Setting  University hospital.

Patients  Forty patients who were going to undergo hepatectomy were assigned prospectively to either a superior mesenteric artery clamp (n=20) or a nonclamp (n=20) group by the random-block method.

Interventions  The Pringle maneuver was used during hepatectomy, and in the superior mesenteric artery clamp group the superior mesenteric arteries were clamped simultaneously.

Main Outcome Measures  Amylase activity, isozyme, and creatinine levels in the blood and urine samples were measured before and after surgery, and the amylase creatinine clearance ratio was estimated.

Results  The serum amylase activity levels of the superior mesenteric artery clamp and nonclamp groups did not differ significantly during the 7 postoperative days. The serum amylase activity levels exceeded 250 U/L in 14 patients (group 1) and remained below this level in 26 (group 2). The salivary-type isozyme levels of group 1 increased significantly compared with those of group 2, and the levels of group 2 remained normal. The total amount of amylase excreted in the urine samples of group 1 patients also increased significantly, with the salivary-type isozyme predominating. All the mean amylase creatinine clearance ratios before and after surgery remained normal. The mode ² of the logistic model including the indocyanine green retention rate at 15 minutes and the ratio of the resected liver weight to the whole liver volume showed a significantly increased risk (P=.01).

Conclusion  It is not the increased portal venous pressure caused by use of the Pringle maneuver but the liver function and the extent of liver resection that are considered risk factors for inducing posthepatectomy salivary-type hyperamylasemia.

From the Second Department of Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.