安全な広範肝切除を目的とした門脈枝塞栓術の基礎的および臨床的研究

安全广泛肝切除门静脉分支栓塞的基础与临床研究

基本信息

批准号：
09671298
负责人：
NAGINO Masato
金额：
$ 1.92万
依托单位：
Nagoya University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1997
资助国家：
日本
起止时间：
1997 至 1998
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09671298/
关键词：
Percutaneous transhepatic protal vein embolization Trisegment portal vein embolization Ipsilateral approach Portal plus arterial embolization Portal blood flow velocity Doppler ultrasound Liver regeneration Apoptosis 肝門部胆肝癌胆嚢癌肝切除術

项目摘要

[Clinical Study] 1) We have developed trisegment portal vein embolization in preparation for right or left hepatic trisegmentectomy. In right trisegment embolization, the left medial, right anterior, and right posterior segments were embolized ; in left trisegment embolization, the left lateral, left medial, and right anterior segments were involved. Trisegment enibolization has made hepatic trisegmentectomy safe. 2) Portal plus arterial embolization (dual embolization) was devised, in order to expand the indication of extensive liver resection for patients with poor functional reserve. This new intervention can produce sizable hypertrophy in the non-embolized hepatic segments. 3) Portal blood flow velocity after embolization was estimated using Doppler ultrasound. This study clearly has demonstrated that the hypertrophy rate of non-embolized hepatic segments after embolization is predictable from the extent of the increase in portal blood flow velocity. 4) With Angio-CT, we have found an immediate increase in the hepatic artery blood flow in the embolized hepatic segments after portal vein embolization.[Experimental Study] 1) We have investigated the mechanism of hypertrophy in the non-embolized hepatic segments after portal vein embolization, using portal branch ligated rat model.. From the view point of polymerase activity and mitochondrial function, portal vein embolization induces hepatocyte proliferation in the non-embolized hepatic segments in a way similar to partial hepatectomy. 2) We have also studied the mechanism of atrophy in the embolized hepatic segments after portal vein embolization, using portal branch ligated rat model.. This atrophy results from, not necrosis, apoptosis of hepatocyte. In addition, we have elucidated that nuclear sphingomyelin breakdown with an accumulation of ceramide and/or sphingosine in nuclei may induce the apoptosis of hepatocyte in vivo.

[临床研究] 1）我们已经开发了三角骨门静脉栓塞，以准备右或左肝三角切除术。在右三角刺中，左侧，右前和右后段被栓塞；在左三颗栓塞中，涉及左侧，左侧和右前部段。三角球的归化使肝三丝切除术安全。 2）设计了门户加上动脉栓塞（双重栓塞），以扩大功能储备较差的患者的广泛肝切除的指示。这种新的干预措施可以在非膨胀的肝段中产生相当大的肥大。 3）使用多普勒超声估算栓塞后的门口血流速度。这项研究清楚地表明，栓塞后非栓塞肝片段的肥大速率可以从门户血流速度的增加程度中预测。 4) With Angio-CT, we have found an immediate increase in the hepatic artery blood flow in the embolized hepatic segments after portal vein embolization.[Experimental Study] 1) We have investigated the mechanism of hypertrophy in the non-embolized hepatic segments after portal vein embolization, using portal branch ligated rat model.. From the view point of polymerase activity and mitochondrial function, portal vein栓塞以类似于部分肝切除术的方式诱导非膨胀肝片段中的肝细胞增殖。 2）我们还研究了门静脉栓塞后的栓塞肝段中萎缩的机理，使用门户分支结扎的大鼠模型。这种萎缩是由于肝细胞的坏死而不是坏死，肝细胞的凋亡。此外，我们已经阐明了核鞘磷脂分解，神经酰胺和/或鞘氨醇在核中的积累可能诱导体内肝细胞的凋亡。