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<beta>反映肝脏线粒体（NAD/NADH，氧化还原状态）的血酮比（乙酰乙酸/β-羟基丁酸，BKBR）的方法：通过测定BKBR，可以在肝癌患者术前、术中和术后频繁测定氧化还原状态，以预防根治性大面积肝切除术后的肝功能不全.肝活检小标本细胞色素氧化酶活性测定体系的建立：肝硬化患者肝细胞色素c氧化酶的含量和比活性均高于非肝硬化患者。术前评估线粒体功能成为可能.“氧化还原耐受试验”的建议：在口服葡萄糖耐量试验（75 gm）期间，同时测量血糖和BKBR的变化。在肝功能储备降低的患者中，血糖升高并不像无肝病患者那样伴随着BKBR的升高。术前评估氧化还原状态是可能的。通过BKBR系列试验预防大块肝切除术期间肝线粒体的代谢应激：发现一些药物和手术程序对线粒体功能具有抑制作用，导致大块肝切除术期间BKBR降低。研究发现，预防手术期间BKBR的降低对于预防术后肝功能衰竭至关重要。介绍使用Bio-Pump进行大面积肝切除术的体外循环：为了预防BKBR降低和术中大出血，发现Bio-Pump的应用对大面积肝切除术有用，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.