Appraisal of Anterior Approach in Right Hepatic Lobectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: Despite recent advances in liver surgery, complication and mortality rate in hepatectomy are still high compared to other abdominal surgeries. Intraoperative stress such as bleeding, vascular occlusion, excessive mobilization and prolonged operation time is the most important factor in postoperative complications. Anterior approach avoiding hepatic mobilization and vascular occlusion in right hepatic lobectomy is a useful method for decreasing intraoperative stress. We investigated the effectiveness of anterior approach in right hepatic lobectomy. METHODS: We studied 33 cases of right hepatic lobectomy for malignant tumor between January 1993 and June1997. Thre were 13 cases of Anterior approach (group A) and 20 cases of classic right hepatic lobectomy (group B). We analyzed liver function test, arterial ketone body ratio(AKBR), operation time, blood transfusion during operation, hospital stay, and postoperative complications. RESULTS: Total bilirubin levels at first and seventh postoperative days were 2.1+/-0.6mg/dl, 0.9+/-0.2mg/dl in group A and 2.7+/-1.3mg/dl, 1.0+/-0.3mg/dl in group B. AST were 189+/-65.3 IU/L, 43+/-13.5 IU/L in group A and 325+/-67.8 IU/L, 51+/-18.2 IU/L in group B. ALT were 169+/-30.5 IU/L, 52+/-17.4 IU/L in group A and 295+/-70.3 IU/L, 52+/-16.6 IU/L in group B. AKBR at intraoperative and immediate postoperative period were 0.58+/-0.06, 0.62+/-0.03 in group A and 0.38+/-0.04, 0.40+/-0.08 in group B. Neither operation time (in group A : 380.5+/-61.1 minutes, in group B : 342.9+/-54.8 minutes), transfusion volume during operation (group A : 1222+/-802cc, group B : 1410+/-476cc), nor hospital stay (group A : 22.8+/-3.5 days, group B : 19.1+/-1.4 days) were different between the two groups. Complication rate was lower in group A compared to that of group B (30.8% vs. 40.0%). There was 1 mortality in group B and no mortality in group A. CONCLUSIONS: It is suggested that right hepatic lobectomy through the anterior approach is a useful surgical procedure to reduce intraoperative surgical stress and postoperative complications.

Acute exercise induces mitochondrial swelling of hepatocytes surrounding the terminal hepatic venule in rat liver acinus / 体力科学

In this study, we investigated the effect of acute exercise on the mitochondrial structure of hepatocytes surrounding the terminal hepatic venule (zone III) in the rat liver acinus. Male SD rats were assigned to a resting group (n=8) and to running groups ran on a motor-driven treadmill for 100 min (n = 8) or did continued running beyond 100 min until exhaustion (n = 5) . Plasma guanase activity was increased with duration time of exercise. The arterial ketone body rate (AKBR) increased during the 100 min of running, but the AKBR significantly diminished with exhaustive running as compared with that for 100 min of running. Although there was no change in the mitochondrial structure of hepatocytes in the perportal area (zone I) during exhaustion, remarkable swelling was observed in that in zone III.<BR>These results suggest that acute running affects mitochondrial structures in zone III, and that this might be a hypoxia zone during exercise.