|Budget Amount *help
¥7,000,000 (Direct Cost : ¥7,000,000)
Fiscal Year 1990 : ¥800,000 (Direct Cost : ¥800,000)
Fiscal Year 1989 : ¥6,200,000 (Direct Cost : ¥6,200,000)
The relationship of the liver and the pancreas, and resectability of the liver in simultaneous hepatopancreatic resection will be evaluated. This research has been divided into the following two projects.
1. Clinical Study : Fifteen cases with biliary tract cancer were performed hepatopancreatectomy. Procedures were pancreaticoduodenectomy (14 cases), distal subtotal pancreatectomy (One case), hepatic subsegmentectomy (8 cases), and lobectmy, extended lobectomy and trisegmentectomy (7 cases). Postoperative hapatic failure occurred in 6 cases, and 5 in these 6 cases had been has performed extended lobectomy. And 3 in these 5 cases died from hepatic failure. Massive blood loss (over 500 ml) and/or long time operation (over 15 hours) promoted hepatic failure after operation. On the other hand, plasma exchange cured two cases with postoperative hepatic failure, one case with extended locectomy, the another case with trisegmentecotomy. It was concluded that the maximum resectable hepatic vol
ume without postoperative hepatic failure was tow segments, and trisegment was a resectable limit by the aid of hepatic adist for instanece plasma exchange.
2. Expetimental Study : Three groups of canine were made, as following groups of control, 40% hepatectomy, and 70% pancreatectomy plus 40% hepatectomy. Dynamic change of circulation of these groups was evaluated intraoperatively. Pancreatectomy made peripheral vascular resistance increase, and systemic blood pressure, heart rate, and left ventricular stroke index decrese, and blood flow of portal vein reduce into 60%. Following hepatectomy made pulmonary wedge pressure decrease, peripheral vascular resistance increase, and blood flow of portal vein further decrease into 30%. In spite of recovery of cardiac out put when peritoneal cavity closed, blood flow of portal vei was kept reduced.
According to these studies, it was concluded that some chemical mediator originated from the pancreas made hepatic blood flow suppress after pancreatectomy, and this affected liver function and causes hepatic failure following hepatectomy. Less