Quantification of operative stress for radical extended hepatectomy

我们应用“氧化还原理论”进行了安全的肝切除手术，取得了良好的效果。1.肝脏外科评分(HSS)的发展：定义HSS为术中动脉酮体比(AKBR)时间进程中小于0.7的总面积。该评分与术后代谢变化有较好的一致性，并能预测术后并发症及多器官功能衰竭的发生。2.HSS在术中术后监护中的应用：多因素分析表明，术中应激抑制AKBR主要受术前肝功能、年龄等因素的影响。因此，这一评分可能是个体肝脏储备能力的一个综合指标。明确了术中动态监测AKBR对于确定手术安全界限和预测术后状态是不可避免的。3.减少HSS的新手术方法：制定了防止肝脏活动的手术方法--经门静脉水平部入路和经膈入路。对于被认为是肝切除禁忌症的门静脉、肝静脉和下腔静脉癌栓病例，应用自体静脉移植或生物泵的应用从HSS的角度确保了手术的安全。此外，在肝切除术中原位或非原位灌流肝脏的方法目前正在研究中。4.其他：明确了人肝标本中细胞色素氧化酶c活性反映了术中应激程度。肝切除后线粒体膜的脂质成分发生了变化，肝组织和线粒体中维生素K的含量也受到肝切除的影响。

We performed a hepatectomy safely by the application of the "Redox theory" and obtained the following excellent results. 1. development of the hepatic surgical score (HSS): HSS was defined as the total area below 0.7 on the time course of arterial ketone body ratio (AKBR) during operation. This score corresponded with the postoperative metabolic changes well, and it was also able to predict the postoperative complications and the development of the multiple organ failure. 2. Application of HSS to the intra- and postoperative intensive care: A multivariate analysis proved that the AKBR suppressed by the intraoperative stress was largely influenced by such factors as a preoperative liver function and an age. Therefore, it was suggested that this score may be a total index of the hepatic reserve capacity of individuals. And it was clarified that serial measurements of the AKBR during operation was inevitable for the determination of the safety limit of the operative procedure and the prediction of the postoperative status. 3. Novel operative methods to minimize HSS: The procedures to prevent the mobilization of the liver - approach via the horizontal portion of the portal vein and transphrenic approach - were developed. For the cases of the tumor thrombus of the protal vein, hepatic vein and inferior vena cava, which were considered to be contraindication for liver resection, application of venous autograft or Bio-pump ensured safe operations from the standpoint of HSS. Moreover, the method of perfusing the liver in situ or ex situ during hepatectomy is now being investigated. 4. Others: It was clarified that cytochrome oxidase c activities in human liver specimen reflected the degree of the intraoperative surgical stress. It was also clarified that the mitochondrial membrane changed in its lipid components after hepatectomy and that the content of vitamin K in the liver tissue and mitochondria was also influenced by hepatectomy.