Usui M, Hayasaki A, Fujii T, Iizawa Y, Kato H, Tanemura A, Murata Y, Azumi Y, Kuriyama N, Kishiwada M, Mizuno S, Sakurai H, Isaji S
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Transplant Proc. 2018 Nov;50(9):2690-2694. doi: 10.1016/j.transproceed.2018.03.037. Epub 2018 Mar 16.
Daikenchuto (DKT), a Japanese Kampo medicine, had been reported to increase small intestinal blood flow after liver resection. The aim of this study was to evaluate the effects of early enteral feeding of DKT on portal venous flow and early bowel movement after living donor liver transplantation (LDLT) in an attempt to clarify whether these effects on bowel motility can prevent bacterial and/or fungal translocation.
Our prospective study included the consecutive 16 LDLT recipients at Mie University Hospital between June 2006 and September 2009. Sixteen patients were divided into the 2 groups according to enteral feeding starting postoperative day (POD) 1: 8 patients in DKT (15 g/d) administration (DKT group, for 1 week) and 8 patients in tepid water administration (non-DKT group, for 1 week). Portal venous flow, portal venous pressure, presence of fungal infection (serum level of β-D-glucan and fungal polymerase chain reaction assay), time to first food intake, and time to first defecation were serially examined.
Portal venous flow (mean [SD] velocity) was significantly increased in DKT group compared with non-DKT group: 47.5 (12.9) vs 31.8 (15.4) (P = .04) on POD 1, 46.8 (11.5) vs 28.8 (12.5) (P = .03) on POD 3, and 42.3 (17.2) vs 25.2 (9.0) (P = .05) on POD 5. However, mean (SD) portal venous pressures did not significantly change between the 2 groups. Between the 2 groups (DKT vs non-DKT), the day of first oral intake was not significantly different: 6.9 (2.5) vs 11.3 (8.7) (P = .061), but the mean (SD) day of first defecation was significantly shorter in the DKT group: 3.9 (1.1) vs 5.5 (2.6) (P = .02). Although fungal polymerase chain reaction assay was not significantly different between the 2 groups (4 vs 4 positive cases), the mean (SD) serum levels of β-D-glucan were significantly lower in the DKT group than in the non-DKT group: 9.0 (7.4) vs 18.4 (15.9) pg/mL (P = .04).
Early enteral feeding of DKT after LDLT increased portal vein blood flow without increasing portal vein pressure and stimulated early bowel movement, which in turn might prevent fungal translocation.
大建中汤（DKT）是一种日本汉方药物，据报道在肝切除术后可增加小肠血流量。本研究的目的是评估活体肝移植（LDLT）后早期肠内给予DKT对门静脉血流和早期排便的影响，以试图阐明这些对肠道蠕动的影响是否能预防细菌和/或真菌移位。
我们的前瞻性研究纳入了2006年6月至2009年9月在三重大学医院连续接受LDLT的16例受者。16例患者根据术后第1天开始肠内喂养分为2组：8例给予DKT（15 g/d）（DKT组，持续1周），8例给予温水（非DKT组，持续1周）。连续检测门静脉血流、门静脉压力、真菌感染情况（血清β - D - 葡聚糖水平和真菌聚合酶链反应检测）、首次进食时间和首次排便时间。
与非DKT组相比，DKT组门静脉血流（平均[标准差]速度）显著增加：术后第1天为47.5（12.9）对31.8（15.4）（P = 0.04），术后第3天为46.8（11.5）对28.8（12.5）（P = 0.03），术后第5天为42.3（17.2）对25.2（9.0）（P = 0.05）。然而，两组之间的平均（标准差）门静脉压力没有显著变化。两组（DKT组与非DKT组）之间，首次经口进食的天数没有显著差异：6.9（2.5）对11.3（8.7）（P = 0.061），但DKT组首次排便的平均（标准差）天数显著缩短：3.9（1.1）对5.5（2.6）（P = 0.02）。虽然两组之间真菌聚合酶链反应检测没有显著差异（阳性病例均为4例），但DKT组的平均（标准差）血清β - D - 葡聚糖水平显著低于非DKT组：9.0（7.4）对18.4（15.9）pg/mL（P = 0.04）。
LDLT后早期肠内给予DKT可增加门静脉血流量而不增加门静脉压力，并刺激早期排便，这反过来可能预防真菌移位。
