1994 Fiscal Year Annual Research Report

肝門部胆管癌手術の根治性および安全性を高めるための基礎的および臨床的研究

Research Project

Project/Area Number	04404050
Research Institution	Nagoya University
Principal Investigator	二村雄次名古屋大学, 医学部, 教授 (80126888)
Co-Investigator(Kenkyū-buntansha)	宮地正彦名古屋大学, 医学部, 助手 (80242874) 梛野正人名古屋大学, 医学部, 助手 (20237564) 近藤哲名古屋大学, 医学部, 講師 (30215454) 神谷順一名古屋大学, 医学部, 講師 (70194975)
Keywords	肝門部胆管癌 / 術後肝不全 / 門脈枝塞栓術 / 肝再生能 / 胆管炎 / 閉塞性黄疸 / 胆道ドレナージ / xanthine oxidase
Research Abstract	1.ラットでのアロプリノール投与の検討:ラットにxanthine oxidaseの特異的inhibitorであるアロプリノール50mg/day2日間経口により投与により、肝でのxanthine oxidase活性は80%抑制され、肝虚血時のxanthine oxidase活性の増加も抑制された。ラット肝での肝再生能の検討:a)DNA polymerase-α,mitotic indexによる肝細胞の再生能は閉塞性黄疸により亢進し、胆汁を外瘻ドレナージするとこの肝再生能の亢進は減少した。しかし内瘻ドレナージでは肝再生能の亢進は維持された。門脈枝結紮により非結紮葉の肝再生も亢進し、さらに閉塞性黄疸を付加しても肝再生能の亢進は認められ、内瘻ドレナージでは肝再生能の亢進は維持された。b)閉塞性黄疸による肝障害ラットモデルでは内瘻ドレナージ14日後に肝障害は著明に改善したが、閉塞性黄疸に胆管炎合併モデルでは肝障害はわずかに改善したのみであった。 3.術前切除側門脈枝閉塞術による非閉塞肝機能および術後肝不全発生に及ぼす影響:閉塞性黄疸を伴った肝門部胆管癌症例において術前に全肝ドレナージを行いつつ、切除予定側の門脈枝塞栓術を行い、その2週間後には、残存予定肝の容積は12%増加した。さらに残存予定肝の胆汁分泌能も亢進した。残存予定肝の機能を亢進させることにより、術後肝不全の発生は1例もなかった。以上から肝門部胆管癌手術の根治性および安全性を高めるためには、術前に切除予定側も含め、全肝ドレナージが必要であり、切除予定側の門脈枝塞栓術は術後肝不全発生を減少させ、手術適応例を増加させることが可能となった。

Research Products
(17 results)

All Other

All Publications (17 results)

[Publications] Nagino M: "Percutaneous transhepatic ciliary drainage in patients with malignant biliary obstruction of the hepatic confluence" Hepato-Gastroenterologv. 39. 296-300 (1992)
[Publications] Kanai M: "Mitochondrial dysfunction in the non-obstructed lobe of rat liver after selective biliary obstruction" Hepato-Gastroenterology. 39. 385-391 (1992)
[Publications] Nagino M: "Logistic regression and discriminant analyses of hepatic failure after liver resection" World Journal of Surgery. 17. 250-255 (1993)
[Publications] Bhuiya MMR: "Carcinoma of the hepatic hilus with superficial spreading to the intrahepatic segmental bile ducts:report of a case" Journal of Hepato-Biliary-Pancreatic Surgery. 1. 22-26 (1993)
[Publications] Nagino M: "Percutaneous transhepatic portal embolization using newly devised catheters:Preliminary report" World Journal of Surgery. 17. 520-524 (1993)
[Publications] Bhuiya MMR: "Clinicopathologic factors influencing survival of patients with bile duct carcinoma:Multivariate statistical analysis" World Journal of Surgery. 17. 653-657 (1993)
[Publications] Kin Y: "Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy" World Journal of Surgery. 18. 143-149 (1994)
[Publications] Yuasa N: "Angiographic changes in the hepatic artery after skeletonization resection for biliary tract cancer" Gastrointestinal Endoscopy. 40. 92-93 (1994)
[Publications] Kamiya J: "Preoperative cholangiography of the caudate lobe:Surgical anatomy and staging for biliary carcinoma" Journal of Hepato-Biliary-Pancreatic Surgery. 1. 385-389 (1994)
[Publications] I.Nagano: "Hepatic mitochondrial changes in experimental obstructive jaundice complicated by biliary infection" Hepatogastroenterology. 41. 432-437 (1994)
[Publications] S.Kato: "Hepatic recovery after biliary drainage in experimental obstructive joundice complicated by biliary infection" Hepatogastroenterology. 41. 217-221 (1994)
[Publications] Iyomasa,S.: "Successful management of prcopcrative cholangins by pcrcutancous transcpatic biliary drainage:Casc report of advanced gallbladdcr carcinoma with scvcre chotangitis" J.Hep.Bil.Pancr. 4. 424-428 (1994)
[Publications] Nagino M: "Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization" Hepatology. 21. 434-439 (1995)
[Publications] Nagino M: "Disseminated intravascular coagulation after liver resection:Retrospective study in patients with biliary tract carcinoma" Sugery. (in press).
[Publications] Nagino M: "Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma" Surgery. (in press).
[Publications] Nagino M: "Preoperative managemant of hilar cholangiocarcinoma" Journal of Hepato-Biliary-Pancreatic Surgery. (in press).
[Publications] Nagino M: "Changes in hepatic lobar function after right portal vein embolization" Annals of Surgery. (in press).

1994 Fiscal Year Annual Research Report

肝門部胆管癌手術の根治性および安全性を高めるための基礎的および臨床的研究

Principal Investigator

二村 雄次 名古屋大学, 医学部, 教授 (80126888)

Research Products

[Publications] Nagino M: "Percutaneous transhepatic ciliary drainage in patients with malignant biliary obstruction of the hepatic confluence" Hepato-Gastroenterologv. 39. 296-300 (1992)

[Publications] Kanai M: "Mitochondrial dysfunction in the non-obstructed lobe of rat liver after selective biliary obstruction" Hepato-Gastroenterology. 39. 385-391 (1992)

[Publications] Nagino M: "Logistic regression and discriminant analyses of hepatic failure after liver resection" World Journal of Surgery. 17. 250-255 (1993)

[Publications] Bhuiya MMR: "Carcinoma of the hepatic hilus with superficial spreading to the intrahepatic segmental bile ducts:report of a case" Journal of Hepato-Biliary-Pancreatic Surgery. 1. 22-26 (1993)

[Publications] Nagino M: "Percutaneous transhepatic portal embolization using newly devised catheters:Preliminary report" World Journal of Surgery. 17. 520-524 (1993)

[Publications] Bhuiya MMR: "Clinicopathologic factors influencing survival of patients with bile duct carcinoma:Multivariate statistical analysis" World Journal of Surgery. 17. 653-657 (1993)

[Publications] Kin Y: "Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy" World Journal of Surgery. 18. 143-149 (1994)

[Publications] Yuasa N: "Angiographic changes in the hepatic artery after skeletonization resection for biliary tract cancer" Gastrointestinal Endoscopy. 40. 92-93 (1994)

[Publications] Kamiya J: "Preoperative cholangiography of the caudate lobe:Surgical anatomy and staging for biliary carcinoma" Journal of Hepato-Biliary-Pancreatic Surgery. 1. 385-389 (1994)

[Publications] I.Nagano: "Hepatic mitochondrial changes in experimental obstructive jaundice complicated by biliary infection" Hepatogastroenterology. 41. 432-437 (1994)

[Publications] S.Kato: "Hepatic recovery after biliary drainage in experimental obstructive joundice complicated by biliary infection" Hepatogastroenterology. 41. 217-221 (1994)

[Publications] Iyomasa,S.: "Successful management of prcopcrative cholangins by pcrcutancous transcpatic biliary drainage:Casc report of advanced gallbladdcr carcinoma with scvcre chotangitis" J.Hep.Bil.Pancr. 4. 424-428 (1994)

[Publications] Nagino M: "Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization" Hepatology. 21. 434-439 (1995)

[Publications] Nagino M: "Disseminated intravascular coagulation after liver resection:Retrospective study in patients with biliary tract carcinoma" Sugery. (in press).

[Publications] Nagino M: "Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma" Surgery. (in press).

[Publications] Nagino M: "Preoperative managemant of hilar cholangiocarcinoma" Journal of Hepato-Biliary-Pancreatic Surgery. (in press).

[Publications] Nagino M: "Changes in hepatic lobar function after right portal vein embolization" Annals of Surgery. (in press).

二村雄次名古屋大学, 医学部, 教授 (80126888)