Hepatic Mitochondrial Redox State and Hepatic Venous Oxygen Saturation in Relation to Hyperbilirubinemia after Esophageal Cancer Surgery

Nobuhiro Sato, Keisuke Koeda, Kenichiro Ikeda, Kouki Ohtsuka, Yusuke Kimura, Kaoru Ishida, Kazuyoshi Saito

Department of Surgery, I, Iwate Medical University, School of Medicine

The influence of an intraoperative hepatic blood supply disturbance during esophageal cancer surgery for postoperative hyperbilirubinemia was investigated in 37 postsurgical patients. The arterial blood ketone body ratio (AKBR) and hepatic venous oxygen saturation were determined by using an optical catheter implanted into the hepatic vein for continuous monitoring, and both were found to be markers of hepatic oxygen demand and supply. The postoperative peak serum bilirubin level (peak-Bil) of each patient correlated with the intraoperative systemic hemodynamics, the intraoperative systemic hemodynamics, the total time during which the hepatic venous oxygen saturation was below 60% (ShvO2), and the AKBR. Regression analysis revealed a significant correlation between the log (AKBR) and ShvO2 (r=-0.486, p<0.05). a significant correlation was also noted between the peak-Bil and log (AKBR) or ShvO2 (r=-9,464, p<0.01, r=0.499, p<0.05, respectively). However, despite these significant peak-Bil and AKBR or ShvO2 correlations, no relationship was found between the systemic hemodynamics and these parameters, suggesting that the AKBR and ShvO2 may be useful for monitoring latent liver hypoxia during surgery. These findings thus support the hypothesis that intrahepatic cholestasis occurring after esophageal cancer surgery results from a hepatic energy charge disturbance due to liver hypoxia during the surgical procedure.

Key words
esophageal cancer surgery, postoperative hyperbilirubinemia, arterial blood ketone body ratio, hepatic venous oxygen saturation

Reprint requests
Nobuhiro Sato Department of Surgery, I, Iwate Medical University, School of Medicine
19-1 Uchimaru, Morioka, 020 JAPAN

Accepted
January 11, 1995

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