Einfluss des Pringle-Manövers bei Kryochirurgie der Schweineleber: Möglichkeit zur Reduktion Kryotherapie-assoziierter Thrombozytopenie?

Abstract

Background

in case of cryosurgery of the liver, cryotherapy-associated thrombocytopenia is known as a common complication. However, the pathomechanism is not known yet. The aim of this study was to elucidate whether Pringle’s manoeuvre during freezing serves to minimise the extent of cryo-induced thrombocytopenia.

Methods

In a pig liver model (n = 21) cryosurgery was performed under maintained liver perfusion and during Pringle’s manoeuvre. Maximal cryolesions (n = 10) were performed as well as survival experiments with moderate cryotherapy (n = 11). During the observation period, determination of thrombocytes, leukocytes, ASAT, ALAT, LDH and immunohistological examinations at the end of the experiment was performed.

Results

Cryosurgery leads to a significant decrease of thrombocyte count in all experimental groups; leukocytes, ASAT, ALAT and LDH rise significantly in each group during the observation period. Histological analysis reveals an accumulation of thrombocytes in the border region of the cryolesion. Pringle’s manoeuvre leads to a significantly greater expansion of the cryozone when compared to maintained perfusion.

Conclusion

Cryotherapy-associated thrombocytopenia represents a local accumulation phenomenon of thrombocytes. By use of selective Pringle’s manoeuvre during cryotherapy freeze capacity may be improved with similar systemic side effects.