1989 Fiscal Year Final Research Report Summary
Quantification of operative stress for radical extended hepatectomy
| Project/Area Number |
63440047
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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 | KYOTO UNIVERSITY |
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Principal Investigator |
OZAWA Kazue Kyoto University, Faculty of Medicine Professor and Director, 医学部, 教授 (00026858)
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| Co-Investigator(Kenkyū-buntansha) |
TANAKA Akira Assistant, 医学部, 助手
MORI Keiichiro Assistant, 医学部, 助手 (80159186)
SHIMAHARA Yasuyuki Assistant, 医学部, 助手 (30196498)
YAMAOKA Yoshio Kyoto University Faculty of Medicine Assistant Professor, 医学部, 講師 (90089102)
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| Project Period (FY) |
1988 – 1989
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| Keywords | Redox theory / Arterial ketone body ratio / Hepatic surgical score score / Radical extended hepatectomy |
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| Research Abstract |
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.
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