Title Glucose Intolerance after Major Hepatic Resection : ItsMechanism and Clinical Meanings

Glucose tolerance test i弓 veryuseful in better understanding the stage of the regenerating process in the remnant liver during the early postoperative period after major hepatic resection. In clinical cases, glucose tolerance test could provide at least some prognostic information concerning operative risk, late survival and the likelyhood of early postoperative liver failure in hepatectorr山edpatients. In 70% hepatectomized rabbits, the glucose tolerance patterns after an oral glucose load were characterized by a long standing increase of blood glucose for mor巴 than 180 minutes (a linear pattern) at 24 hours after hepatectomy and by a return toward normn.I range within 180 minutes (a parabolic pattern) at 96 hours later. At the linear stage, the concentrations of pyruvate and lactate of the remnant liver increased to 192% and 203% respectively of sham-operated controls at 1 hour after an oral glucose load. At 3 hours after glucose load, the concentrations of glucose-6・phosphate,fructose-6・phosphate、pyruvateand lactate increased to 191%, 192%, 174% and 298%, respectively. By contrast, at the parabolic stage, no significant changes after glucose load were observed compared with those of sham-operated controls. The energy charge level of the remnant liver decreased rapidly and reached the lowest level of 0.767 at the linear stage and then returned to near normal level at the parabolic stage. In contrast, mitochondrial phosphorylative activity reached 170% of sham-operated controls at the linear stage and then returned to near normal level at the parabolic stage. Thus, glucose tolerance is closely associated with the changes of the energy charge and mitochondrial phosphorylative activity of the remnant liver. ~ on-esterified fatty acid levels in the plasma reached the highest level of 0.98 mEq/l at the linear stage compared to 0.46 mEq/1 of sham-operated controls. Total ketone body concentrations also reached the highest level of 0.237 μmol/ml at the linear stage compared to 0.133 μ.立叫/凶 ofsham-operated controls. They then returned to almost normal