Quantification of operative stress for radical extended hepatectomy

根治性扩大肝切除术手术应激的量化

基本信息

批准号：
63440047
负责人：
OZAWA Kazue
金额：
$ 12.22万
依托单位：
KYOTO UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (A)
财政年份：
1988
资助国家：
日本
起止时间：
1988 至 1989
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-63440047/
关键词：
Redox theory Arterial ketone body ratio Hepatic surgical score score Radical extended hepatectomy Redox理論 Redox State score AKBR Bio-Pump 肝切除

项目摘要

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.

我们通过应用“氧化还原理论”安全地进行了肝切除术，并获得了以下出色的结果。 1。肝手术评分（HSS）：HSS的发展定义为在手术过程中动脉酮体比率（AKBR）的时间过程中总面积低于0.7。该分数与术后代谢变化良好相对应，并且还能够预测术后并发症和多器官衰竭的发展。 2。将HSS应用于术中和术后重症监护：多变量分析证明，术中应力抑制的AKBR在很大程度上受到术前肝功能和年龄等因素的影响。因此，建议该分数可能是个人肝储备能力的总指数。可以澄清的是，在操作过程中，AKBR的串行测量是确定手术程序的安全限制和术后状态的预测。 3.最小化HSS的新型手术方法：开发了通过门静脉和跨性别方法的水平部分动员肝脏方法的程序。对于肝静脉的肿瘤血栓，肝静脉和下腔静脉，被认为是肝切除的禁忌症，静脉自体移植或生物泵的应用确保了从HSS的角度来确保安全操作。此外，现在正在研究肝切除术期间肝脏原位或原位肝脏的方法。 4。其他：澄清说，人肝脏标本中的细胞色素氧化酶C活性反映了术中手术应激的程度。还澄清说，线粒体膜在肝切除术后其脂质成分发生变化，并且肝组织和线粒体中维生素K的含量也受肝切除术的影响。