Quantification of operative stress for radical extended hepatectomy

我们应用“氧化还原理论”安全地进行了肝切除术，并获得了以下良好的结果。1.肝外科评分（HSS）的制定：HSS定义为术中动脉酮体比率（AKBR）时程上低于0.7的总面积。该评分能较好地反映术后代谢变化，并能预测术后并发症及多器官功能衰竭的发生。2. HSS在术中和术后重症监护中的应用：多因素分析证明，术前肝功能和年龄等因素对术中应激抑制的AKBR有很大影响。因此，建议该评分可作为个体肝脏储备能力的总指标。术中连续测量AKBR对于确定手术安全限度和预测术后状态是不可避免的。3.最大限度减少HSS的新手术方法：开发了防止肝脏活动的手术-经门静脉水平部分入路和经皮入路。对于门静脉、肝静脉和下腔静脉癌栓被认为是肝脏切除禁忌症的病例，从HSS的角度来看，应用自体静脉移植物或Bio-pump可以确保手术安全。此外，肝切除术中原位或异位灌注肝脏的方法正在研究中。4.其他：阐明了人肝脏标本中细胞色素氧化酶c活性反映了术中手术应激的程度。还阐明了肝切除术后线粒体膜的脂质成分发生变化，肝组织和线粒体中维生素K的含量也受到肝切除术的影响。

We performed a hepatectomy safely by the application of the "Redox theory" and obtained the following excellent results. 1. development of the hepatic surgical score (HSS): HSS was defined as the total area below 0.7 on the time course of arterial ketone body ratio (AKBR) during operation. This score corresponded with the postoperative metabolic changes well, and it was also able to predict the postoperative complications and the development of the multiple organ failure. 2. Application of HSS to the intra- and postoperative intensive care: A multivariate analysis proved that the AKBR suppressed by the intraoperative stress was largely influenced by such factors as a preoperative liver function and an age. Therefore, it was suggested that this score may be a total index of the hepatic reserve capacity of individuals. And it was clarified that serial measurements of the AKBR during operation was inevitable for the determination of the safety limit of the operative procedure and the prediction of the postoperative status. 3. Novel operative methods to minimize HSS: The procedures to prevent the mobilization of the liver - approach via the horizontal portion of the portal vein and transphrenic approach - were developed. For the cases of the tumor thrombus of the protal vein, hepatic vein and inferior vena cava, which were considered to be contraindication for liver resection, application of venous autograft or Bio-pump ensured safe operations from the standpoint of HSS. Moreover, the method of perfusing the liver in situ or ex situ during hepatectomy is now being investigated. 4. Others: It was clarified that cytochrome oxidase c activities in human liver specimen reflected the degree of the intraoperative surgical stress. It was also clarified that the mitochondrial membrane changed in its lipid components after hepatectomy and that the content of vitamin K in the liver tissue and mitochondria was also influenced by hepatectomy.