How to improve the safety of total hepatic vascular exclusion for hepatectomy in hepatoma with cirrhosis

1.新的肝脏血流动力学和代谢测量系统的布置：将肝动脉、门静脉和肝静脉的血流量和氧分压同时输入计算机，可连续测量肝脏的耗氧量。全肝阻断引起的肝损伤比入肝血流阻断更严重，因为肝静脉回流可以为低氧肝脏提供氧气。然而。与正常大鼠一样，温水浸泡诱导热休克蛋白对肝硬变大鼠是有用的。然而，在肝硬变动物中，太长时间的浸泡是非常有害的，因此需要温和的暖和。通过检测热休克蛋白的m-RNA可以实现对热休克蛋白诱导的早期检测。肝内或肠系膜上动脉灌注PG-E1可增加肝血流量和肝组织氧供给量，对预防和改善肝动脉阻断后的肝功能衰竭具有重要作用。结论：术前预适应热休克蛋白诱导，围手术期经肝动脉或肠系膜上动脉灌注前列腺素E_1可提高全肝血流阻断的安全性。

1. Arrangement of the new system for measuring hemodynamic and metabolism of the liver : Blood flow and oxygen tension of the hepatic artery, portal vein and hepatic vein are imputed simultaneously in the computer, from which oxygen consumption of the liver can be measured continuously.2. Hepatic damage caused by total hepatic exclusion is more serious than that by hepatic inflow occlusion, in Which back flow from hepatic vein can supply oxygen to the hypoxic liver. however.3. Induction of heat shock protein using warm water immersion is useful in the cirrhotic rats as is observed in normal. In cirrhotic animals, however, too long immersion is so harmful that gentle warming is necessary. Earlier detection of induction of heat shock protein can be achieved by measuring m-RNA of the heat shock protein.4. Intra hepatic or superior mesenteric arterial infusion of PG-E1 increases hepatic blood flow and oxygen delivery in the hepatic tissue, which is effective for prevention and improvement of hepatic failure after hepatic arterial occlusion. The effect of the treatment can be realized in patients of hepatic arterial embolisation for the rupture of hepatic arterial pseudoaneurysm.Conclusion : Preconditioning of heat shock protein induction before operation, and infusion of PGE1 via hepatic or superior mesenteric artery around operation can improve the safety of total hepatic vascular exclusion in cirrhotic.