Experomental and clinical studies to increase curability and safety of surgery for hilar cholangiocarcinoma
| Project/Area Number |
04404050
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| Research Category |
Grant-in-Aid for General Scientific Research (A)
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| Allocation Type | Single-year Grants |
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| Research Field |
Digestive surgery
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| Research Institution | Nagoya University |
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Principal Investigator |
NIMURA Yuji Nagoya University School of Medicine Professor, 医学部, 教授 (80126888)
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| Co-Investigator(Kenkyū-buntansha) |
KANAI Michio Nagoya University School of Medicine Associate Professor, 医学部, 助手 (50242871)
MIYACHI Masahiko Nagoya University School of Medicine Associate Professor, 医学部, 助手 (80242874)
NAGINO Masato Nagoya University School of Medicine Associate Professor, 医学部, 助手 (20237564)
KONDO Satoshi Nagoya University School of Medicine Associate Professor, 医学部, 講師 (30215454)
KAMIYA Junichi Nagoya University School of Medicine Associate Professor, 医学部, 講師 (70194975)
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| Project Period (FY) |
1992 – 1994
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| Project Status |
Completed (Fiscal Year 1994)
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| Budget Amount *help |
¥19,500,000 (Direct Cost: ¥19,500,000)
Fiscal Year 1994: ¥4,000,000 (Direct Cost: ¥4,000,000)
Fiscal Year 1993: ¥6,000,000 (Direct Cost: ¥6,000,000)
Fiscal Year 1992: ¥9,500,000 (Direct Cost: ¥9,500,000)
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| Keywords | Hilar cholangiocarcinoma / Obstructive Jaundice / Hepatectomy / Liver failure / Portal vein embolization / Biliary drainage / Cholangitis / Caudate lobe / 肝再生能 / 胆道ドレナージ / xanthine oxidase / 肝虚血 / histo chemistry / 虚血再潅流障害 / xanthine oxiclase / histochemistry / free radicals |
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| Research Abstract |
*Clinical Research*
(1) Preoperative accurate diagnosis of cancer extent was achievable using cholangiography throgh biliary drainage catheter, percutaneous transhepatic cholangioscopy, selective angiography, pcrcutaneous transhepatic portography and hepatic venography. This, in turn led to rational surgical prcoedures. (2) Perineural lnvasion proved to have a profound impact on survival of the patients with bile duct carcinoma, indicating that thorough skeletonization resection is essential for curative intent. (3) We developed a new approach of percutaneous transhepatic portal vein cmbolization, the ipsilateral approach, which made it possible to embolize the right or left trisegment portal vein. Portal vein cmbolization had the potential to increase safety of and to extend indication of major hepatectomy for hilar cholangiocarcinoma. (4) Technique of multiple selective biliary for hilar cholangiocarcinoma was well established by the direct anterior approach under fluoroscopic control
… More
. This aggressive drainage was essential for preventing and/or treating segmental cholangitis in patients with malignant biliary obstruction at the hepatic confluence.
*Experimental Research*
The following resukts were demonstrated experimentally using rats or mioe. (1) External bilisry drainage, unlike internal drainage, does not suppress regcenration of cholestatic liver after partial hepatectomy. (2) Biliary infection, especially associated with obstructive jaundice, injures hepatic mitochondrial function markedly. Biliary drainage is definitely effective in improving the impaierd function. (3) Under a condition of selective biliary obstruction, hepatic mitochondrial function is decreased also in the non-cholestatic lobe, as well as the cholestatic lobc. This implies that biliary drainage of the entire biliary system is beneficial. (4) An application of lipid emulsion to total parenteral nutrition is useful for hepatic regeneration after partial hepatectomy. (5) Portal branch ligation induces hepatocyte proliferation in the non-ligated lobe in a way similar to partial hepatectomy, from the viewpoint of changes in DNA polymerases and mitochondrial gene expression. (6) Portal branch ligation induces hepatocyte proliferation in the non-ligated lobe, irrespective of obstructive jaundice. (7) An increment in IL-10 production in the liver is involved in the protective effect of dibutyryl cAMP on inflammatory liver injury. Less
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Report
(4 results)
Research Products
(41 results)
