肝門部血行遮断時の門脈二重バイパス循環法に関する実験的研究―臓器組織血流および循環動態について―

In clinical resection of advanced carcinoma of the bile duct, portal double bypass (superior mesenteric vein-IVC and femoral artery-portal vein) has been devised and successfully used during complete simultaneous blockage of the hepatic artery and the portal vein at hepatic hilum ; for the purpose of maintaining the hepatic circulation and avoiding splanchnic congestion. However, the safe range of blood flow rate during the bypass has not been determined accurately. The safety level of arterial portal flow towards the liver controlled by a pump in the bypass, for maintaining satisfactory systemic and hepatic hemodynamics was determined using a similar model in mongrel dogs. Systemic hemodynamics were monitored using a Swan-Ganz catheter and hepatic blood flow was measured by an electromagnetic method and laser doppler method. The safe flow rate of bypass circulation ranged from 25 to 75% of the normal total hepatic flow ; hepatic damage was induced. When the hepatic flow was below 25%, while systemic hemodynamics collapsed by the shunting effect at a hepatic flow rate above 75%.

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