Hemostasia do parênquima hepático, utilizando eletrocautério seco ou emplastrado com lidocaína ou neomicina ou glicerina ou vaselina, em coelho

Abstract

Hepatic hemorrhage after accidental trauma or during surgical procedures may be intense and difficult to control. It is responsibility of surgeon to achieve adequate hemostasis during hepatic resection or in major injuries to the parenchyma in order to prevent complications and death. The volume of blood lost is decisive for the postoperative prognosis of these patients. Bile leakage is another severe complication that can result in peritonitis, sepsis and death. Several techniques and instruments have been developed to permit safe hepatic resectionwith reduced bleeding. Topical agents are also used as an adjuvant measure to facilitate hemostasis. The objective of the present study was to assess the hemostasis and healing of the hepatic parenchyma in an experimental model after segmental hepatectomy, using a dry electrocautery or an electrocautery greased with lidocaine gel, neomycin pomade, glycerin lotion, or vaseline pomade. The efficacy of these procedures was compared regarding the blood volume lost and the timespent to achieve hemostasis. Histological changes in the hepatic wound and of hematologic and functional liver changes were assessed as well.Male New Zealand rabbits were submitted to partial hepatectomy anddivided into six groups of 10 animals each: untreated (Group C), treated with a dry electrocautery (Group S), or treated with an electrocautery greased with lidocaine gel (Group L), neomycin pomade (Group N), glycerine lotion (Group G), or vaseline pomade (Group V). Resected liver weight, bleeding volume and time spent to achieve hemostasis were determined. Five rabbits from each group were reoperated upon after 24 hours and five after 7 days in order to obtain a biopsy of the hepatic wound and to explore he abdominal cavity. Red blood cell levels andmarkers of hepatic function and injury were verified before surgery and before reoperation. Lidocaine gel and glycerine lotion reduced the bleeding volume and the time to achieve hemostasis compared to the untreated group and the groups treated with neomycin or vaseline. Lidocaine gel and glycerine lotion conduct the thermal energy of the electrocautery, causing hydropic cell degeneration after 24 hours anddeeper necrosis of hepatic tissue after 7 days. All the substances used in this work increased aminotransferase concentrations to values above those of the control group and of the group treated with the dry electrocautery after 24 hours. These values returned to normal after a maximum of seven days. In conclusion, the electrocautery greased with lidocaine gel and glycerine lotion were the most effective method for the hemostasis of hepatic parenchyma.