| Budget Amount *help |
¥2,310,000 (Direct Cost: ¥2,100,000、Indirect Cost: ¥210,000)
Fiscal Year 2007: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Fiscal Year 2006: ¥1,400,000 (Direct Cost: ¥1,400,000)
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| Research Abstract |
Portal pressure will be elevated by massive hepatectomy, and induce damage to the remnant liver. The elevated intra-sinusoidal pressure is thought to cause injury of the endothelial cells and hepatocytes. In liver transplantation, a small-for-size graft less than 0.8% of recipient body weight will cause the graft syndrome with hyper-bilirubinemia, elevated liver enzymes, coagulopathy and delayed functional recovery. To solve the portal hypertension, several tactics are issued such as splenic arterial ligation, splenectomy or porto-caval shunting. In addition, liver transplantation surgeons showed dual left lobe graft transplantation, mesocaval shunting, and auxiliary partial orthotopic liver transplantation. About these methods discussions come out with merits and demerits later Therefore, we designed resection of the small intestine and subsequent massive hepatectomy using animals to solve the clinical problem of excessively elevated portal pressure in massive hepatectomy or in small-
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for-size graft liver transplantation. Aiming at an appropriate volume of the jejunectomy to reduce the excessively elevated portal pressure, we designed different sizes of the jejunectomy followed by 80% hepatectomy on rats.
MATERIALS & METHODS : Fifteen SD rats were divided into 3 groups, Group A ; performed with only 80% (medial 2 and left lateral lobes plus left caudate lobe) hepatectomy, Group B ; 50% jejunectomy (25% of the small intestine) followed by the hepatectomy, and Group C ; jejunectomy (50% of the small intestine) followed by the same hepatectomy. The ileocolic vein was cannulated with a handmade thin indwelling catheter to measure the portal pressure. The effects of the jejunectomy on portal hypertension induced by the hepatectomy were studied with hemodynamics and histology of the remnant liver concerning congestion and apoptosis.
RESULTS : Portal pressure was significantly elevated by 80% hepatectomy in Group A (n=5, 10.24±2.12mmHg), whereas Group B showed the pressure decreased by jejunectomy, then the pressure returned to neutral level after the hepatectomy (n=5,6.21±0.80mmHg). Group C (n=5) showed the suppression of the portal pressure to the lower level (n=5,4.54±2.57mmHg) after the hepatectomy than the standard portal pressure (n=15, 6.61±0.75mmHg)
Histology of the remnant liver removed on the day revealed congestion in Group A, but not in Groups B and C. The findings consist of hepatocytic swelling, narrowing of the sinusoidal space, enlargement of the portal area, and dilation of the central vein. These findings of Group A settled down in 1 week, while Groups B and C specimens showed almost normal histology through the week Study of apoptosis in the remnant liver at day 1 and 2 after the hepatectomy showed apoptosic cells in Group A and none in Group B or C.
CONCLUSION : 50% jejunectomy (25% resection of the small intestine) can control the portal hypertension induced by massive hepatectomy. And the jejunectomy may prevent the small-far-size graft syndrome in liver transplantation. Less
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