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幽門側胃切除により短胃動静脈系を温存したにもかかわらず, 術後早期の血流障害によるまれな合併症である残胃壊死の1例を経験した.症例は61歳の女性で, 早期胃癌で幽門側胃切除, Billroth I法再建術をうけた.術後第3病日より発熱, CRPの上昇があり, 胃管より暗血性の悪臭のある排液を認めた.腹部超音波検査にて左横隔膜下に液体貯留があり, 上部消化管透視で造影剤の腹腔内への流出を認め, 術後第7病日縫合不全の診断により緊急手術となった.開腹所見は脾動脈の閉塞のため短胃動脈で養われていた残胃の血流障害により大彎側前壁で穿孔を認め, 残胃全摘, 脾摘, Roux-Y再建術を施行した.術後左横隔膜下膿瘍を認めたが軽快退院した.残胃壊死の発生頻度は低いものの適切な処置がなされなければ死亡率70%といわれ.壊死が広範囲のものは早期発見による残胃全摘術が唯一の救命処置と思われた.

We investigated the effect of oxygen supply on hepatic cellular viability during cold perfusion storage of rat livers. A perfluoro-N-methyldecahydroisoquinoline (FMIQ) emulsion is used as an oxygen carrier. The composition of the perfusate containing 20 w/v% FMIQ is essentially the same as the University of Wisconsin (UW) solution except for the exclusion of hydroxyethyl starch. Rat livers were perfused at 4 degrees C for up to 24 h with either UW solution (group I, oxygenated; group II, unoxygenated) or FMIQ solution (group III, oxygenated; group IV, unoxygenated). After perfusion storage, the livers were reperfused with warm (37 degrees C) oxygenated or cold (4 degrees C) unoxygenated Krebs-Henseleit bicarbonate buffer, and nuclear trypan blue uptake was measured as the index of cell death. With warm oxygenated reperfusion, there remained less than 2% noviable parenchymal cells up to 24 h, regardless of perfusate or oxygenation. In UW-perfused livers, the proportion of nonviable nonprenchymal cells (NPC) increased progressively regardless of oxygenation, the values in groups I and II in the periportal field at 24 h being 39.9 +/- 4.7% (mean +/- SD) and 36.5 +/- 4.2%, respectively. By contrast, in FMIQ-perfused livers, dye uptake by NPC was significantly reduced with oxygenation (16.9 +/- 5.7% and 39.4% +/- 9.1% at 24 h in groups III and IV; P < 0.001). With cold unoxygenated reperfusion, livers in groups I, II, and IV showed a significant decrease of nonviable NPC, while those in group III showed no significant changes. These data indicate that oxygen supply during perfusion storage of the liver may ameliorate lethal injury to NPC precipitated during reperfusion.