Retional management of patients with hepatic malignancies for redical massive hepatectomy - with special reference to metabolic internsive care besed on "Redox theory".

1.建立一种简便而准确的测定血酮体比率(乙酰乙酸酯/β-羟丁酸，BKBR)的方法，以反映肝脏线粒体(NAD/NADH，氧化还原状态)：通过检测BKBR，可以在肝脏恶性肿瘤患者的术前、术中和术后频繁地测定氧化还原状态，以预防根治性肝切除术后肝功能不全的发生。肝活检小标本细胞色素外切酶活性测定体系的建立：与非肝硬化性肝组织相比，肝硬化性肝组织中细胞色素c-氧合酶的含量和比活性均升高。术前评估线粒体功能成为可能。“氧化还原耐量试验”的建议：在口服葡萄糖耐量试验(75gm)时，同时测定血糖和BKBR的变化。在肝功能储备降低的患者中，无肝病患者的血糖升高并不像预期的那样伴随BKBR的升高。术前评估氧化还原状态是可行的。BKBR系列检测预防大鼠肝切除时肝线粒体代谢应激的研究：发现一些药物和外科手术对线粒体功能有抑制作用，导致大鼠肝切除时BKBR下降。术中防止BKBR下降是预防术后肝功能衰竭的关键。生物泵用于大范围肝切除的体外循环：为了防止BKBR下降和术中大出血，生物泵的应用对于大范围肝切除是有效的，没有任何并发症。

1. Developement of a simplified and accurate method for the determination of blood-ketone-body ratio (acetoacetate/<beta>-hydroxybutyrate, BKBR) reflecting liver mitochondrial (NAD/NADH, Redox state): Frequent determinations of redox state in patients with hepatic malignancies dueing pre-, intra-, and postoperative period have become possible to prevent hepatic insufficiency after radical massive hepatectomy by the assaying BKBR.2. Establishment of assay system for cytochrome exydase activity using small specimen of liver biopsy: Both the content and specific activity of cytochrome c oxydase in cirrhotic liver was increased as compared with non-cirrhotic liver. Preoperative evaluation of mitochondrial function became possible.3. Proposal of "Redox tolerance test": During oral glucose tolerance test (75 gm) changes in blood sugar and BKBR were measured simultaneously. In the patients with lowered hepatic functional reserve, the increase in the blood sugar did not accompanied with that of BKBR as expected in patients without liver diseases. Preoperative evaluation of redox state was found to be possible.4. Prevention of metabolic stress on liver mitochondria during massive hepatectomy by serial assay of BKBR: some drugs and surgical procedures were found to have an inhibitory effect on mitochondrial function leading to a decrease in BKBR during massive hepatectomy. Prevention of the decrease in BKBR during surgery was found to be crucial for the prevention of postoperative liver failure.5. Introduction of extracorporeal circulation using Bio-Pump for massive hepatectomy: For the prevention of both decrease in BKBR and massive bleeding during surgery, application of Bio-Pump was found to be useful for a massive hepatectomy without any complications.