障害肝切除前後の病態生理と肝予備能把握に関する研究

概要

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The pathophysiology and hepatic functional reserve for hepatectomy were experimentally and clinically investigated in liver cirrhosis in view of resectability. In experimental studies, liver cirrhosis in rat was produced by long term thioacetamide administration. In rats, livr regeneration after hepatectomy in cirrhosis initiated at the same time to that of normal liver, but the former was noticed to be less in its degree than the latter because of functional changes of the liver cell membrane and depression of energy production for the recovery in cirrhosis. The pathophysiology related to decreased functional hepatic reserve was revealed well by the measurement of serum mGOT, polyamines, plasma c-AMP after glucagon loading and ICG maximal removal rate (ICG Rmax). In clinical studies, the combined examination of ICG Rmax, mGOT especially apo mGOT and c-AMP after glucagon loading in addition to the conventional hepatic functional examinations showed preoperatively the exact hepatic functional reserve for hepatectomy. It may be concluded that the hepatic resection for liver cirrhosis may be critical when ICG Rmax is below 0.4mg/kg/min, apo mGOT is above 10 Karmen Unit and plasma c-AMP peak level after glucagon loading is under 1000 p moles/ml.
神戸大学の論文