臨床外科77巻1号

2022年01月発行

特集 外科医が知っておくべき—《最新版》栄養療法

各論

肝臓外科における栄養療法

著者： 山田大作¹ 小林省吾¹ 佐々木一樹¹ 岩上佳史¹ 富丸慶人¹ 野田剛広¹ 高橋秀典¹ 土岐祐一郎¹ 江口英利¹

所属機関： ¹大阪大学大学院消化器外科学

ページ範囲：P.66 - P.69

文献概要

【ポイント】
◆肝切除は背景肝が肝障害であることが多く，肝臓容積の回復に有利な環境を整え，損なわれた肝機能による影響を最小限とする栄養管理が要求される．
◆周術期の絶食期間は患者の肝疾患に合わせた工夫が有用である．
◆周術期BCAAやprobiotics投与は肝再生を促し，周術期感染症を減らして，周術期に有利に働くことが期待される．

参考文献

1）Masuda T, Shirabe K, Yoshiya S, et al：Nutrition support and infections associated with hepatic resection and liver transplantation in patients with chronic liver disease. JPEN J Parenter Enteral Nutr 37：318-326, 2013

2）Merli M, Nicolini G, Angeloni S, et al：Malnutrition is a risk factor in cirrhotic patients undergoing surgery. Nutrition 18：978-986, 2002

3）Nutritional status in cirrhosis. Italian Multicentre Cooperative Project on Nutrition in Liver Cirrhosis. J Hepatol 21：317-325, 1994

4）Tsuchiya M, Sakaida I, Okamoto M, et al：The effect of a late evening snack in patients with liver cirrhosis. Hepatol Res 31：95-103, 2005

5）Fukushima H, Miwa Y, Ida E, et al：Nocturnal branched-chain amino acid administration improves protein metabolism in patients with liver cirrhosis：comparison with daytime administration. JPEN J Parenter Enteral Nutr 27：315-322, 2003

6）Bianchi G, Marzocchi R, Agostini F, et al：Update on nutritional supplementation with branched-chain amino acids. Curr Opin Clin Nutr Metab Care 8：83-87, 2005

7）Zhan C, Dai X, Shen G, et al：Preoperative short-term fasting protects liver injury in patients undergoing hepatectomy. Ann Transl Med 6：449, 2018

8）Rickenbacher A, Jang JH, Limani P, et al：Fasting protects liver from ischemic injury through Sirt1-mediated downregulation of circulating HMGB1 in mice. J Hepatol 61：301-308, 2014

9）Qin J, Zhou J, Dai X, et al：Short-term starvation attenuates liver ischemia-reperfusion injury（IRI）by Sirt1-autophagy signaling in mice. Am J Transl Res 8：3364-3375, 2016

10）Cornide-Petronio ME, Álvarez-Mercado AI, Jiménez-Castro MB, et al：Current knowledge about the effect of nutritional status, supplemented nutrition diet, and gut microbiota on hepatic ischemia-reperfusion and regeneration in liver surgery. Nutrients 12：284, 2020

11）Hine C, Harputlugil E, Zhang Y, et al：Endogenous hydrogen sulfide production is essential for dietary restriction benefits. Cell 160：132-144, 2015

12）Nanno Y, Toyama H, Terai S, et al：Preoperative oral branched-chain amino acid supplementation suppresses intraoperative and postoperative blood lactate levels in patients undergoing major hepatectomy. JPEN J Parenter Enteral Nutr 43：220-225, 2019

13）Bifari F, Nisoli E：Branched-chain amino acids differently modulate catabolic and anabolic states in mammals：a pharmacological point of view. Br J Pharmacol 174：1366-1377, 2017

14）Ijichi C, Matsumura T, Tsuji T, et al：Branched-chain amino acids promote albumin synthesis in rat primary hepatocytes through the mTOR signal transduction system. Biochem Biophys Res Commun 303：59-64, 2003

15）Hoffmann K, Büchler MW, Schemmer P：Supplementation of amino acids to prevent reperfusion injury after liver surgery and transplantation--where do we stand today? Clin Nutr 30：143-147, 2011

16）Ishikawa T, Michitaka I, Kamimura H, et al：Oral branched-chain amino acids administration improves impaired liver dysfunction after radiofrequency ablation therapy for hepatocellular carcinoma. Hepatogastroenterology 56：1491-1495, 2009

17）Kuroda H, Ushio A, Miyamoto Y, et al：Effects of branched-chain amino acid-enriched nutrient for patients with hepatocellular carcinoma following radiofrequency ablation：a one-year prospective trial. J Gastroenterol Hepatol 25：1550-1555, 2010

18）Borruel N, Carol M, Casellas F, et al：Increased mucosal tumour necrosis factor alpha production in Crohn's disease can be downregulated ex vivo by probiotic bacteria. Gut 51：659-664, 2002

19）McCarthy J, O'Mahony L, O'Callaghan L, et al：Double blind, placebo controlled trial of two probiotic strains in interleukin 10 knockout mice and mechanistic link with cytokine balance. Gut 52：975-980, 2003

20）Chen P, Schnabl B：Host-microbiome interactions in alcoholic liver disease. Gut Liver 8：237-241, 2014

21）Boursier J, Mueller O, Barret M, et al：The severity of nonalcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota. Hepatology 63：764-775, 2016

22）Del Chierico F, Nobili V, Vernocchi P, et al：Gut microbiota profiling of pediatric nonalcoholic fatty liver disease and obese patients unveiled by an integrated meta-omics-based approach. Hepatology 65：451-464, 2017

23）Liu Z, Li C, Huang M, et al：Positive regulatory effects of perioperative probiotic treatment on postoperative liver complications after colorectal liver metastases surgery：a double-center and double-blind randomized clinical trial. BMC Gastroenterol 15：34, 2015

24）Tanphaichitr V, Leelahagul P：Carnitine metabolism and human carnitine deficiency. Nutrition 9：246-254, 1993

25）Malaguarnera M, Pistone G, Astuto M, et al：L-carnitine in the treatment of mild or moderate hepatic encephalopathy. Dig Dis 21：271-275, 2003

26）Malaguarnera M, Pistone G, Elvira R, et al：Effects of L-carnitine in patients with hepatic encephalopathy. World J Gastroenterol 11：7197-7202, 2005

27）Müller MJ：Malnutrition in cirrhosis. J Hepatol 23（Suppl 1）：31-35, 1995

28）Riggio O, Ariosto F, Merli M, et al：Short-term oral zinc supplementation does not improve chronic hepatic encephalopathy. Dig Dis Sci 36：1204-1208, 1991

29）Reynolds PS, Fisher BJ, McCarter J, et al：Interventional vitamin C：a strategy for attenuation of coagulopathy and inflammation in a swine multiple injuries model. J Trauma Acute Care Surg 85（1S Suppl 2）：S57-S67, 2018

30）Miyauchi T, Uchida Y, Kadono K, et al：Preventive effect of antioxidative nutrient-rich enteral diet against liver ischemia and reperfusion injury. JPEN J Parenter Enteral Nutr 43：133-144, 2019