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设计：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，由此可以连续测量肝脏的氧耗.全肝血流阻断对肝脏的损害比肝血流阻断严重，肝静脉回流可为缺氧肝脏供氧。然而。用温水浸泡诱导热休克蛋白在正常大鼠中是有用的。然而，对于冬眠动物来说，太长时间的浸泡是非常有害的，因此需要温和的加热。通过检测热休克蛋白mRNA的表达，可以实现对热休克蛋白诱导的早期检测.经肝内或上级肠系膜动脉灌注PG-E1可增加肝血流量和肝组织氧供，对预防和改善肝动脉阻断后的肝功能衰竭有效。结论：术前热休克蛋白诱导预处理，围术期经肝动脉或上级肠系膜动脉灌注PGE 1，可提高全肝血流阻断术的安全性。

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.