Yokoyama Yukihiro, Nagino Masato, Nimura Yuji
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Surg Today. 2007;37(10):823-30. doi: 10.1007/s00595-007-3508-6. Epub 2007 Sep 26.
Liver surgery is a process which induces various types of stress on the liver including the total occlusion of the blood inflow, hemorrhage, massive volume reduction, and postoperative infection. Animal studies have shown a gender dimorphic response of the liver for various stresses such as ischemia/reperfusion, hemorrhage/resuscitation, hepatectomy, portal branch ligation, and endotoxemia. Most of these studies demonstrated the female liver to be more tolerant under stressful conditions than the male liver. Estrogen, which is a representative female sex hormone, may be one of the responsible factors for this gender dimorphism. The mechanism of estrogen's salutary effect includes circulatory improvement, a reduced inflammatory response, a reduced oxygen radical production, and an improved hepatic regeneration. However, the clinical evidence that supports the results of these experimental studies is still insufficient. A well-controlled prospective clinical study is necessary to clarify the role of gender or sex hormone in the process of liver surgery. This may not only lead to a deeper understanding of the liver pathophysiology, but also to the possibility of hepatoprotective therapy using sex hormone modulators. This review summarizes the current understanding of gender dimorphism in the tolerance of the liver to various hepatic stresses, which occur during the process of major liver surgery.
肝脏手术是一个会给肝脏带来多种应激的过程，包括血流完全阻断、出血、大量体积缩小以及术后感染。动物研究表明，肝脏对诸如缺血/再灌注、出血/复苏、肝切除、门静脉分支结扎和内毒素血症等多种应激存在性别二态性反应。这些研究大多表明，在应激条件下，雌性肝脏比雄性肝脏更具耐受性。雌激素作为一种典型的雌性激素，可能是导致这种性别二态性的因素之一。雌激素有益作用的机制包括改善循环、减轻炎症反应、减少氧自由基产生以及促进肝脏再生。然而，支持这些实验研究结果的临床证据仍然不足。有必要进行一项严格控制的前瞻性临床研究，以阐明性别或性激素在肝脏手术过程中的作用。这不仅可能有助于更深入地理解肝脏病理生理学，还可能带来使用性激素调节剂进行肝脏保护治疗的可能性。本综述总结了目前对在主要肝脏手术过程中肝脏对各种肝脏应激耐受性方面性别二态性的理解。
