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、准确的测定反映肝脏线粒体（NAD/NADH，氧化还原状态）的血酮体比（乙酰乙酸/< β - >-羟基丁酸，BKBR）的方法：在肝恶性肿瘤患者术前、术中和术后频繁测定氧化还原状态，通过测定BKBR预防根治性肝切除术后肝功能不全成为可能。肝活检小标本细胞色素氧化酶活性测定系统的建立：肝硬化肝脏细胞色素氧化酶含量和比活性均高于非肝硬化肝脏。术前评估线粒体功能成为可能。“氧化还原耐量试验”的提出：在口服葡萄糖耐量试验（75 gm）中，同时测量血糖和BKBR的变化。在肝功能储备降低的患者中，血糖的升高并没有像没有肝病的患者那样伴随着BKBR的升高。术前评估氧化还原状态是可能的。通过BKBR系列测定预防大肝癌切除术中肝脏线粒体代谢应激：发现一些药物和外科手术对线粒体功能有抑制作用，导致大肝癌切除术中BKBR下降。预防术中BKBR的降低是预防术后肝衰竭的关键。体外循环应用Bio-Pump进行肝大切除术：为了预防术中BKBR降低和大出血，应用Bio-Pump进行肝大切除术无任何并发症。

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.