| Project/Area Number |
60480310
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| Research Category |
Grant-in-Aid for General Scientific Research (B)
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| Allocation Type | Single-year Grants |
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| Research Field |
Digestive surgery
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| Research Institution | School of Medicine, Keio University |
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Principal Investigator |
TSUZUKI Toshiharu Department of Surgery, Keio University School of Medicine, 医学部, 助教授 (80051192)
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| Co-Investigator(Kenkyū-buntansha) |
OZAWA Iwao Department of Surgery, Keio University School of Medicine, 医学部, 助手 (10152464)
SUGIOKA Atsushi Department of Surgery, Keio University School of Medicine, 医学部, 助手 (20171150)
IIDA Shuhei Department of Surgery, Keio University School of Medicine, 医学部, 助手 (00101973)
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| Project Period (FY) |
1985 – 1986
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| Project Status |
Completed (Fiscal Year 1986)
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| Budget Amount *help |
¥6,400,000 (Direct Cost: ¥6,400,000)
Fiscal Year 1986: ¥600,000 (Direct Cost: ¥600,000)
Fiscal Year 1985: ¥5,800,000 (Direct Cost: ¥5,800,000)
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| Keywords | Hepatocellular carcinoma / Hepatic vein / Inferior vena cava / Tumor thrombi / 肝切除 |
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| Research Abstract |
Hepatocellular carcinoma tends to spread through tumor thrombi in the portal vein, hepatic vein and inferior vena cava. Tumor thrombi in the portal vein can be removed without difficulty but tumor thrombi in the hepatic vein extending into the inferior vena cava can only be extracted by vascular exclusion technique which consisted of clamping of hepatic artery, portal vein, infra-and supra hepatic inferior vena cava. Two patients underwent this precedure. Right trisegmentectomy and removal of tumor thrombus in the right portal vein extending into the inferior vena cava was performed using vascular exclusion of 26 minutes duration. In another patient metastatic left suprarenal tumor with tumor thrombus extending from the left suprarenal vein into the inferior vena cava was extirpated with the use of vascular exclusion of 10 minutes duration. It was shown that vascular exclusion of more than 20 minutes duration was followed by decrease in cardiac output, fall in blood pressure with elevation of peripheral vascular resistance. This was due to bleeding which was the result of congestion of the remnant liver. To establish the simple and safe operative procedure, an experimental study was carried out. Thirty eight dogs were used to clarify the usefulness of bypass procedure which diverts blood in the portal vein or inferior vena cava or both into the superior vena cava. Twenty three dogs undergoing vascular exclusion of 45 minutes duration were attended by high operative mortality. Thus, the second series of experiment was performed in 15 dogs with the use of vascular exclusion of 30 minutes. It was shown that dogs having bypass of the portal vein or portal vein and inferior vena cava underwent less remarkable changes in circulatory dynamics than that of dogs having no bypass. This result suggests feasiblity of bypass procedure.
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