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Non-touch isolation hepatectomy and extra-corporeal anticancer therapy for liver tumors-Feedback of surgical technique in living-related partial liver transplantation to liver surgery-

非接触隔离肝切除及肝脏肿瘤体外抗癌治疗-活体部分肝移植手术技术对肝脏手术的反馈-

基本信息

批准号：
07407035
负责人：
YAMAOKA Yoshio
金额：
$ 13.7万
依托单位：
KYOTO UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (A)
财政年份：
1995
资助国家：
日本
起止时间：
1995 至 1996
项目状态：
已结题

项目摘要

Technical aspects for the development of 'Non-touch isolation method' of hepatectomy for hepatic malignancies were investigated. The liver lobe without malignant tumor was first procured according to the technique for the donation of living-related partial liver transplantation without manipulating the tumor bearing parts of the liver in order to prevent the tumor ce11 dissemination during hepatectomy. The tumor bearing part of the liver was then extirpated in one piece with IVC.For the re-implantation of the preserved healthy liver lobe, reconstructions of the IVC and hepatic vein were of difficulty in this new technique. In the anastomosis between the Gore-Tex vessel for the replaced IVC and hepatic vein, direct anastomosis of the hepatic vein to the lateral wall of Gore-Tex vessel was most suitable both for hepatic drainage and for stabilization of the implanted liver. In the reconstruction of the hepatic artery, end-to-end micro-anastomosis between the hepatic artery and peripheral … More end of the splenic artery using micro-chip for vascular anastomosis was effective to obtain rapid procedure and the good patency. The high rate occurrence of postoperative coagulopathy was the other problem in this technique. Since elastase was easily activated after operation, protease inhibitor was administered throughout the operative period so that the initiation of DIC was not triggered. This prophylactic administration of protease inhibitor made postoperative hemostasis quite easy. As a result, animals could survive more than 10 days overwhelming the postoperative acute phase. The remaining problem is the contro1 of infection due to complicated operative procedure and the usage of artificial vessels.In the part of study for the protection of damaged liver during opertion, activation of 'self-protection mechanism' of the cells utilizing the 'stress response' was most promising. In this study, it was proven that the induction of heat shock protein (HSP) in the liver tissue prior to stressful intervention could confer excellent protection against warm-ischemia reperfusion injury. In the normal livers, 50% mortality in rats due to 30-minute warm ischemia of the liver was improved to more than 95% survival. Recovery of energy metabolism after reperfusion was better maintained as well. This effects was realized even after the induction of HSPs by other methods than heat shock, such as ischemic or pharmacological preconditioning. This protective effects were also demonstrated also in the damaged liver models. In the fibrotic livers produced by carbon tetrachloride, the postischemic survival was improved from 50% to 90%. The survival of the animals with fatty livers, which was produced by the choline deficient diet, was also improved from 33% to 87%. Less

对开发用于治疗肝脏恶性肿瘤的“非接触隔离法”肝切除术的技术方面进行了研究。首先按照活体部分肝移植捐献技术获取无恶性肿瘤的肝叶，不操作肝脏的荷瘤部分，以防止肝切除过程中肿瘤细胞播散。然后用IVC将肝脏的肿瘤部分切除，为了重新植入保留的健康肝叶，重建IVC和肝静脉是这项新技术的困难。在更换下腔静脉的 Gore-Tex 血管与肝静脉的吻合中，肝静脉直接吻合 Gore-Tex 血管的侧壁最适合肝引流和植入肝脏的稳定。在肝动脉重建中，采用微芯片在肝动脉与脾动脉末梢端进行血管吻合的端对端微吻合，手术速度快，通畅性好。术后凝血障碍的高发生率是该技术的另一个问题。由于术后弹性蛋白酶很容易被激活，因此在整个手术期间给予蛋白酶抑制剂，从而不引发DIC。这种蛋白酶抑制剂的预防性给药使术后止血变得非常容易。结果，动物可以在术后急性期存活超过 10 天。剩下的问题是由于复杂的手术过程和人工血管的使用而导致的感染控制。在保护手术期间受损肝脏的研究部分中，利用“应激反应”激活细胞的“自我保护机制”是最有希望的。在这项研究中，证明在应激干预之前在肝组织中诱导热休克蛋白（HSP）可以针对热缺血再灌注损伤提供出色的保护。在正常肝脏中，30分钟肝脏热缺血引起的大鼠50%死亡率改善为95%以上存活率。再灌注后能量代谢的恢复也得到了更好的维持。即使在通过热休克以外的其他方法（例如缺血或药物预处理）诱导热休克蛋白后，也能实现这种效果。这种保护作用也在受损的肝脏模型中得到了证实。在四氯化碳产生的纤维化肝脏中，缺血后存活率从 50% 提高到 90%。由于缺乏胆碱饮食而患有脂肪肝的动物的存活率也从 33% 提高到 87%。较少的