タイムテーブル 第 1 日目 5 月30日（水） - æ ªå¼ä¼šç¤¾ã‚³ãƒ³ã‚°ãƒ¬

PL-1 Liver Surgery Through Verification of Hypothesis
Department of Surgery, Hyogo College of Medicine
○…Jiro…Fujimoto
Although…HBP…surgeon…are…very…busy…without…exception…and…daily…surgical…clinical…work…urged…us…to…
concentrate… to… operation… and… patients,… I… believe… we… have… to… evolve… a… new… theory,… a… new… treatment…
method,… a… new… concept… in… our… surgical… field.……To… achieve… evolution,… the… best… way… is… to… construct… a…
hypothesis…and…verify…the…hypothesis.……Hypothesis…comes…to…us…by…surveying…and…studying…published…
articles… throughout,… or… by… learning… from… experience… of… daily… clinic.… If… the… steps… of… verifying… of… the…
hypothesis…are…faithful…and…accurate,…we…can…make…a…milestone…though…it…might…be…tiny,…in…surgery…in…spite…
of…the…results…of…the…hypothesis.……I…will…present…a…couple…of…my…favorite…works…of…hypothesis…in…liver…
surgery…fields.……The…first…is,…“Liver…volume…can…be…calculated…based…on…portal…circulation…and…the…volume…
estimated…is…approximate…to…actual…resected…liver…volume.”……A…novel…3D…hepatectomy…simulation…software…
was…established…(Patent…No:…283191)…and…it…reliably…predicted…an…accurate…liver…resection…volume,…cancerfree…
margin,… and… drainage… volume… of… hepatic… branches.……This… information… has… changed… operative…
procedures…in…liver…surgery…(1).……Second,…we…hypothesized…“Liver…cirrhosis…is…not…the…irreversible…end…
result…of…chronic…liver…disease…but…can…be…reversible…by…adequate…strategies.”……In…a…rat…model…of…lethal…liver…
cirrhosis…produced…by…liver-toxin,…gene…delivery…of…hepatocyte…growth…factor…rescued…the…rats…and…liver…
fibrosis…was… completely… diminished…(2).……Moreover,… induction…of… collagenase…or… blockage… of… TGF-β…
signaling…also…treated…liver…fibrosis.…Thus,…liver…cirrhosis…is…not…an…irreversible…disease…and…can…be…treated…
by…novel…approaches.……The…third…is,…“Adhesion…formation…after…abdominal…surgery…is…depend…on…both…
inflammatory…and…blood…coagulation,…and…immunological…mechanism…plays…a…key…role…for…adhesion.”……We…
established…an…abdominal…adhesion…mice…model…and…analyzed…molecular…mechanisms.……As…results,…IFN-γ…
produced…from…NKT…cells…plays…a…pivotal…role…for…adhesion…formation…through…differential…regulation…of…
PAI-1…and…tPA…(3).……This…mechanism…is…also…proven…hepatic…resection…model,…thus…might…be…a…ubiquitous…
mechanism… of… adhesion… formation… after… surgery.……I… hope… we… can… diminish… liver… fibrosis,… we… can… do…
operation… without… adhesion… formation,… and… it… contributes…a… lot… to… liver… surgery… field.……I… do… continue…
construction…of…hypothesis…and…verification…of…the…hypothesis.
…
(1)……Saito… S,… Yamanaka… J,… Miura… K,… Nakao… N,… Nagao… T,… Sugimoto… T,… Hirano… T,… Kuroda… N,… Iimuro… Y,…
Fujimoto…J.……A…novel…3D…hepatectomy…simulation…based…on…liver…circulation:…Application…to…liver…
resection…and…Transplantation.…Hepatology…2005;6:…1297-1304
(2)……Ueki… T,… Kaneda… Y,… Tsutsui… H,… Nakanishi… K,… Sawa… Y,… Morishita… R,… Matsumoto… K,… Nakamura… T,…
Takahashi…H,…Okamoto…E,…Fujimoto…J.……Hepatocyte…growth…factor…gene…therapy…of…liver…cirrhosis…in…
rats.……Nature Med…1999;5:…226-230……
(3)……Kosaka… H,… Yoshimoto… T,… Yoshimoto… T,… Fujimoto… J,… Nakanishi… K.……Interferon-g… is… a… therapeutic…
molecule…for…prevention…of…postoperative…adhesion…formation.…Nature Med 2008;…14:…437-441
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