[Diabetes mellitus as a risk factor in major hepatic resection and its strategy by intraportal insulin administration].

Diabetes mellitus, or insulinopenia, is a possible risk factor in major hepatic resection, because insulin is a typical hepatotrophic factor governing hepatic mitochondrial function. By analyzing 91 hepatic resections for hepatocellular carcinoma, we made a multiple regression equation for prediction of postoperative mortality using insulinogenic index (II) and redox tolerance index (RTI) which were both calculated by measuring insulin level and arterial ketone body ratio during oral glucose tolerance test (z = 3.11 x II + 1.43 x RTI - 2.27). When z was negative, the mortality rate was 33.3% in major hepatic resection cases. Since 1990, we have prospectively applied intraportal insulin administration (IIA) therapy as postoperative management to patients with negative z score. In the total 19 patients the postoperative mortality was significantly reduced by the introduction of IIA therapy. Hence, the IIA therapy can be a strategy against diabetes mellitus as a risk factor in major hepatic resection.