Tohoku J. Exp. Med., 2001, 195 (2)

Case Report

Appraisal of Intra-Arterial Infusion of Prostaglandin E₁ in Patients Undergoing Major Hepatic Resection — Report of Four Cases

TSUTOMU SATO, OUKI YASUI, TOSHIAKI KUROKAWA, YOSHIHIRO ASANUMA and KENJI KOYAMA

Department of Surgery, Akita University School of Medicine, Akita 010-8543

In order to reduce risk for postoperative acute liver failure, prostaglandin E₁ (PGE₁) was administered either from the hepatic artery (HA) or the superior mesenteric artery (SMA) in four high-risk cases undergoing major hepatic resection. Two cases were subjected to HA PGE₁ infusion for 3 or 4 days after surgery at a rate of 0.01 mg/kg/min. Both patients had hepatocellular carcinoma (HCC) associated with chronic hepatitis, and ICG R₁₅ was 17.6% and 14.5%, respectively. Right hemihepatectomy and extended right hemihepatectomy were performed. Serum total bilirubin (T. Bil.) peak value was 2.2 mg/100 ml in Case 1 and 2.1 mg/100 ml in Case 2. In Case 1, decreased bile flow was observed immediately after cessation of PGE₁. The other two cases were subjected to SMA PGE₁ infusion for 5 or 6 days after surgery at the same rate. In Case 3, right hemihepatectomy was performed for HCC on a cirrhotic liver four weeks after right portal vein embolization, in which preoperative ICG R₁₅ was 19.0%. Peak T. Bil level was 3.7 mg/100 ml with uneventful postoperative course. In Case 4 with a huge cholangioma, right trisegmentectomy was performed. Peak serum T. Bil level was 1.7 mg/100 ml in this uneventful postoperative course. In Case 3 and Case 4, portal blood flow, measured by Doppler ultrasonography, was markedly increased by PGE₁ infusion. From these results, intra-arterial PGE₁ infusion might be useful in prevention of postoperative liver failure after major hepatic resection.

Keywords —— postoperative acute liver failure; prostaglandin E₁; portal blood flow

© 2001 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2001, 195, 125-133

Address for reprints: Kenji Koyama, M.D., FACS, Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.

e-mail: koyama@surg1.med.akita-u.ac.jp