CLINICAL AND EXPERIMENTAL STUDIES ON THE MAINTENANCE OF SUFFICIENT HEPATIC CIRCULATION WITH ARTERIAL BLOOD DURING THE TEMPORARY OCCLUSION OF THE HILAR HEPATIC CIRCULATION.

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1.Experimental study in mongrel dogs: This study was performed to clarify the safe range of the blood flow volume to maintain the liver function, structure and systemic circulation as possible as normal under the condition of total hilar clamping when the hepatic circulation was supplied only through the extracorporeal catheter bypass from the artery to the hepatic portal vein in flow control.(1)In the study of the energy metabolism of the liver during the bypass circulation, the lowest limit of the arterial blood inflow volume tl maintain the hepatic function was confirmed to be in the range between 10% to 25% of the normal total hepatic blood flow volume.(2)In the study of the morphology of the liver after the bypass circulation for 2 hours, the lowest limit of the arterial blood inflow volume to maintain the hepatic structure normal was confirmed to be in the range between 10% to 25% of the normal total hepatic blood flow volume.The highest limit of that was confirmed to be in the range between 50% to 75% of the normal total hepatic blood flow volume.(3)In the study of the systemic hemodynamics during the bypass circulation, the safe flow rate of bypass circulation ranged from 25% to 75% of the normal total hepatic blood flow volume.2.Clinical studyThis double catheter bypass method was devised to perform block resection of the hepatoduodenal ligament in cases of the carcinoma of the bile duct and head of the pancreas. In the study of 20 clinical cases, this method was confirmed to be safe from the view point of the systemic hemodynamic and liver function tests.