YOKOI Hajime Mie University, Faculty of Medicine, University Hospital, Lecturer, 医学部附属病院, 講師 (60174843)
NOGUCHI Takashi Mie University, Faculty of Medicine, Associate Professor, 医学部, 助教授 (40144258)
KAWARADA Yoshifumi Mie University, College of Medical Sciences, ProFessor, 医療技術短期大学部, 教授 (40024814)
|Budget Amount *help
¥1,400,000 (Direct Cost : ¥1,400,000)
Fiscal Year 1991 : ¥700,000 (Direct Cost : ¥700,000)
Fiscal Year 1990 : ¥700,000 (Direct Cost : ¥700,000)
Obstructive jaundice was produced in adult mongrel dogs by cholecystectomy and ligation-cut off of the di!ktal common bile duct, and the resectability and the tolerable limit of interruption of hepatic blood inflow in the liver with obstructive jaundice were functionally and morphologically evaluated.
(1) Resectability of the liver with obstructive jaundice : When hepatectomy was performed with choledochoduodenostomy 2 weeks after production of obstructive jaundice, the 4-week survival rate was : 71% after 40% hepatectomy and 22% after 70% hepatectomy, respectively. The IGGRmax value before hepatectomy clearly indicated the limit of one-staged hepatectomy. On the other hand, when the choledochoduodenostomy for reduction of jaundice prior to hepatectomy was performed 3 weeks after production of obstructive jaundice, followed by 70% hepatectomy, many dogs that received hepatectomy 2 weeks after choledochoduodenostomy died within 4 weeks after two-staged hepatectomy, because of the insuffi
cient of the reticuloendothelial' system and the coagulation-fibrinolysis system even if the hepatic reserve had been restored above the critical level. The 4-week survival rate. in dogs that underwent hepatectomy 3 weeks after the choledochoduodenostomy was significantly better at 67%.
(2) Tolerable limit of interruption of the hepatic blood inflow : When the blood supply of the liver was interrupted simultaneously with choledochoduodenostomy 2 or 3 weeks after production of obstructive jaundice, the tolerable limits of interruption 2 and 3 weeks after production of, jaundice were 2 hours and I hour, respectively, in the hepatic artery, 20 and 10 minutes in the portal vein, and 10 and 5 minutes in both the hepatic artery and portal vein. The tolerable limit of interruption shortened as the duration of jaundice was longer. Especially, in the dogs that received interruption of the hepatic artery, the cause of death was extensive neurosis of the liver, and the choledochoduodenostomy was not effective even if those that survived, with electron microscopy suggesting significant prolongation of jaundice as compared with the dogs that received the choledochoduodenostomy alone.
(3) Hepatic resectability after interruption of the hepatic blood inflow and reperfusion : In dogs that received 40% hepatectomy and the choledochoduodenostomy after 5- or 10-minute simultaneous interruption of the hepatic artery and the portal vein followed by 60-minute reperfusion 2 or 3 weeks after production of obstructive jaundice, the 1-week survival rate was significantly lower than in those that received the choledochoduodenostomy alone (40% and 20% 2 and 3 weeks, respectively, after production of jaundice). In the former group, lipid peroxides levels of the liver tissue and blood of were increased at both times, respectively. However, the survival rate improved, and the liver injury was milder, when a free radical scavenger such us Coenzyme Q_<10>, Superoxide dismutase and so on was administered before interruption of the hepatic blood inflow. Less