Studies of pathogenesis on remnant liver dysfunction after extended hepatectomy, from the view points of changes in nitric oxide and adhesion molecule expression.

[目的]探讨肝切除后残留肝功能障碍与一氧化氮(NO)变化及黏附分子表达的关系.[材料与方法]实验成年猫分为三组，分别为70%肝切除组(I组)、84%肝切除组(II组)和84%肝切除加脾切除组(III组)，术后24小时连续监测以下指标：1.血清肝功能检测-(1)肝细胞(GOT、GPT、AKBR)，(2)肝窦内皮细胞(透明质酸)；(3)枯否细胞(内毒素)，2.激光多普勒检测肝组织血流，3.近红外分光光度法检测肝组织NO含量(NO-Hb)，5.肝组织ICAM-1的表达(免疫组织化学染色)。[结果]I组术后即刻肝细胞功能的维持优于II组HA LE…另一方面，作为内皮功能的更多的血管内皮功能在术后即刻开始时均显著升高，且与肝组织血流量呈负相关。术后即刻，两组大鼠肝组织中NO含量均显著升高，但II组的变化低于I组。肝组织中ICAM-1的表达在II组中可见，尤其是在肝功能严重受损、HA水平升高、NO水平降低的动物中表达更高。III组内皮细胞功能、Kupffer细胞功能和肝组织血流量均维持在接近I组水平，残留肝细胞功能良好。因此，脾切除组大鼠肝组织中NO水平和ICAM-1表达水平明显高于对照组。[结论]肝组织中NO含量的变化取决于肝内皮细胞的功能和肝组织的血流量。ICAM-1的表达程度和NO水平的变化反映了大范围肝切除术后早期残余肝功能障碍的程度。联合脾切除后NO水平变化和ICAM-1表达均明显改善，提示脾参与了术后早期残留肝功能障碍，尤其是肝窦内皮细胞损伤的进展。较少

[Purpose] This study was performed to elucidate the pathophysiology of the remnant liver dysfunction after extended hepatectomy over functional resectability of the liver, based on the relationships to nitric oxide (NO) changes and adhesion molecule expression.[Materials & Methods] Experimental adult mongorel dogs into three groups, 70%-hepatectomy (Group I), 84%-hepatectomy (Group II) and 84%-hepatectomy with simultaneous splenectomy (Group III), then serially measured following parameters until 24 hours postoperatively : 1.hepatic function test in the serum- (1) hepatocyte (GOT,GPT,AKBR), (2) endothelial cell of hepatic sinusoid (hyaluronic acid ; HA), (3) Kupffer cell (endotoxin), 2.hepatic tissue blood flow by Laser Doppler, 3.Liver tissue NO level (NO-Hb) by near-infrared spectrophotometer, and 5.ICAM-1expression in the liver tissue (immuno-histochemical staining).[Results] The hepatocyte functions were better maintained immediatly postoperatively in Group I than in Group II.HA le … More vels as endothelial function, on the other hand, were both significantly higher beginning immediatly postoperatively and negatively correlated with liver tissue blood flow. Immediately after operation, liver tissue NO levels were significantly higher in both groups, but the changes occurred at lower levels in Group II than Group I.Expression of ICAM-1 in remnant liver tissue was observed in Group II,and was particularly high in the animals with severe liver dysfunction with high HA levels and reduced NO values. In Group III,however, endothelial cell function, Kupffer cell function and liver tissue blood flow were maintained with close to levels of Group I,resulting in good remnant hepatocyte function. Therefore, NO levels and ICAM-1 expression were significantly improved by splenectomy compared with those of Group II.[Conclusion] Liver tissue NO varied depending on the sinusoidal endotherial cell function and liver tissue blood flow. The degree of ICAM-1 expression and the changes of NO levels reflected on the remnant liver dysfunction after extended hepatectomy in the early postoperative period. On the other hand, both the changes in NO levels and ICAM-1 expression were significantly improved by combined resection of spleen, suggesting that the spleen are involved in the remnant liver dysfunction in the early postoperative period, particularly in the progression of sinusoidal endothelial cell damage. Less