00177413

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肝切除術に伴う肝鬱血の回避法に関する新しい試み : In situ家兎肝灌流実験モデルにおける検討

New trial to prevent liver congestion in hepatectomy : a study using in situ rabbit liver perfusion model on the amount of leakage from the section of the liver

Japanese (日本語)

Medical journal of Kobe University

59(1/2/3/4)

63-73

神戸大学医学会

1999-03

2006-08-21

本文ファイルは、国立情報学研究所CiNiiより提供されたものです。

We have developed a new technique reducing blood loss during hepatectomy to prevent the damage caused by interruption of hepatic circulation. Using in situ rabbit liver perfusion model, we measured the leak volume from the raw surface of the liver and also monitored the pressure of inferior vena cava (IVC) just below the diaphragma. Oxygenated 37℃ Krebs-Henseleit solution was infused through the portal vein. To relieve the liver congestion a cannula for drainage was inserted into IVC. A coiled stent was placed into retrohepatic IVC to prevent the wall from collapse under negative pressure drainage. As a preliminary study, we examined the changes in IVC pressure and leak volume under 3 different drainage conditions (insufficient drainage, gravity drainage, negative pressure drainage with a stent). Under insufficient drainage, the leak volume per time gradually increased despite minimal increase in IVC pressure. Then the changes in IVC pressure, leak volume, bile secretion, and the volume of sodium bicarbonate solution infused to keep acid-base balance were compared among three different drainage conditions (experiment 1 : gravity drainage and negative pressure drainage, experiment 2 : gravity drainage with and without liver congestion beforre perfusion, experiment 3 : gravity drainage and negative pressure drainage without liver congestion before perfusion). In experiment 1, the leak volume was significantly reduced by the stent insertion into IVC. In experiment 2, liver congestion before perfusion could cause masssive leakage from the raw surface even without an elevation in IVC pressure. In experiment 3, the negative pressure drainage also contributed to reduce the leak volume in cases without liver congestion before perfusion. In conclusion the leak volume from the raw surface of the liver can be reduced by keeping the retrohepatic IVC pressure low, and negative pressure drainage with a stent contribute to reduce blood loss during hepatectomy.

陰圧脱血

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