Hepatic Resection Using in-situ Cold Perfusion Under Total Vascular Exclusion

全血管阻断下原位冷灌注肝切除术

• 批准号: 01480325
• 负责人: YAMAOKA Yoshio
• 金额: $ 4.42万
• 依托单位: Kyoto University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (B)
• 财政年份: 1989
• 资助国家: 日本
• 起止时间: 1989 至 1990
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-01480325/
• 关键词: Liver resection; Cold perfusion in-situ; Arterial ketone body ratio; 生体肝移植; 体内肝冷却潅流; ケトン対比(KBR); 肝切除率

The hepatic tumors localized close to the IVC or main hepatic veins had been considered to be in-operable, as the tear of these veins produce uncontrollable bleeding unless total vascular occlusion is applied. In this study, the cold perfusion in-situ was performed in dogs experimentally and the results revealed the superiority of UW solution as a perfusate evaluated by Arterial Ketone Body Ratio (AKBR). In a patient with a huge tumor in the right lobe close to the IVC, we applied this method. From the left branch of the portal vein the cold lactate Ringer solution was perfused with a hole in the IVC as a outlet after the total vascular occlusion. Liver resection with a knife and reconstruction of the IVC and the hepatic veins were completed without blood loss. The recovery rate of AKBR after recirculation to the liver was prompt and enough. Using this method the resectability of the liver tumor will increase in future.

位于IVC或主肝静脉附近的肝肿瘤被认为是不可手术的，因为这些静脉的撕裂会产生无法控制的出血，除非应用完全血管闭塞。在本研究中，在实验上对犬进行了原位冷灌注，结果显示UW溶液作为灌注液的优越性，通过动脉酮体比（AKBR）评价。在一个病人的巨大肿瘤在右叶接近下腔静脉，我们采用了这种方法。门静脉左分支灌注冷乳酸林格氏液，在下腔静脉开孔作为血管完全闭塞后的出口。用刀进行肝切除并重建IVC和肝静脉，无失血。AKBR再循环至肝脏后的回收率迅速且足够。采用这种方法，肝肿瘤的可切除性将在未来增加。

项目成果

Y.Shimahara,T.Kiuchi,Y.Yamamoto,et al.: "Hepatic mitochondrial redox potensial and nutrirional support in liver insufficiency." Nutritional Support in Organ Failure,Elsevir,Amsterdam,

Y.Shimahara、T.Kiuchi、Y.Yamamoto 等人：“肝功能不全时的肝线粒体氧化还原电位和营养支持。”

Y . Yamaoka, Y. Taki, G. Gubernatis, et al.: "Evaluation of the liver graft before procerement. Significance of arterial ketone body ratio in brain-dead patients." Transplant. Int.3. 78-81 (1990)

是的。

Y. Yamaoka, K. Ozawa, A. Tanaka, et al.: "New device for harvesting the hepatic graft from the living donor." Transplantation.

Y. Yamaoka、K. Ozawa、A. Tanaka 等人：“从活体捐赠者身上获取肝移植物的新装置。”

T.Kiuchi,Y.Shimahara,S.Wakashiro,et al: "Reduced arterial ketone body ratio during laporotomy:An evaluation of operative stress through the changes in hepatic mitochondrial redox potential." J.Lab Clin Med. 115. 433-440 (1990)

T.Kiuchi、Y.Shimahara、S.Wakashiro 等人：“剖腹术期间动脉酮体比率降低：通过肝线粒体氧化还原电位的变化评估手术应激。”

A.Maki,Y.Sakai,A.Tanaka,et al.: "Influence of piecemeal necrosis on the Compensatory increase of mitochondrial respiratory enzymes of the tumorーbearing liver:Clinical Study of 53 Surgical cases." J.Gastroenterology and Hepatology. 5. 7-15 (1990)

A.Maki、Y.Sakai、A.Tanaka 等人：“分段坏死对荷瘤肝脏线粒体呼吸酶代偿性增加的影响：53 例外科病例的临床研究。” 5. 7-15 (1990)