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

如何提高肝硬化肝癌肝切除全肝血管阻断的安全性

• 批准号: 09470261
• 负责人: KOYAMA Kenji
• 金额: $ 8.51万
• 依托单位: Akita University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 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-09470261/
• 关键词: Hepatic cirrhosis; hepatoma; hepatic vascular exclusion; hepatic metabolism; heat shock protein

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.

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。

项目成果

Sato Ts, Koyama K et al.: "Enhanced cytokine production in peripheral blood monocytes following hepatic resection." Hepatology Research. 10. 193‐199 (1998)

Sato Ts, Koyama K 等人：“肝切除术后外周血单核细胞中细胞因子的产生增强。” 10. 193-199 (1998)。

Sato Ts, Koyama K et al.: "Enhanced cytokine production in peripheral blood monocytes following hepatic resection." Hepatology Research. 10. 193-199 (1998)

Sato Ts、Koyama K 等人：“肝切除术后外周血单核细胞中细胞因子的产生增强。”

Sato Ts, Koyama K et al.: "Differennce in hepatic tissue oxygenation between total vascular exclusion and inflow occlusioin of the liver and the passible role of hepatic venous blood under liver ischemia." Digestive Surgery. 15. 15-20 (1998)

Sato Ts、Koyama K 等人：“肝脏全血管排除和流入闭塞之间肝组织氧合的差异以及肝脏缺血下肝静脉血的作用。”

明石 建, 小山 研二 ほか: "一過性部分肝血行遮断後の遮断葉、 非遮断葉における壊死と再生についての実験的研究、" 日本消化器外科学会雑誌. 31・9. 1978-1985 (1998)

Ken Akashi、Kenji Koyama 等：“短暂性部分肝血循环闭塞后阻塞和未阻塞肝叶的坏死和再生的实验研究”，日本胃肠外科杂志 31・9（1998 年）。

草野智之, 小山研二 ほか: "温水浸漬前処置による肝障害軽減効果ーー肝heat shock protein72との関連においてーー" 肝臓. 40・1. 20-28 (1999)

Tomoyuki Kusano、Kenji Koyama 等：“温水浸泡预处理对减少肝损伤的效果 - 与肝脏热休克蛋白 72 相关 -” 肝脏 20・1（1999）。