Intraportal Insulin Therapy after Partial Hepatectomy for Hepatoma Patients with Insulinopenia

Abstract

This prospective study was carried out in order to assess the role of intraportal insulin infusion after partial hepatectomy in hepatoma patients with insulinopenia. Of the 35 patients who underwent hepatic resections for hepatocellular carcinoma from August 1994 through July 1995, 20 patients took an oral glucose tolerance test with insulin measurement preoperatively. Nine patients(45%) were found to be insulinopenic. Four patients were treated postoperatively with intraportal insulin infusion, as follows. A 16-gauge catheter was inserted into a reopened umbilical vein and fixed in place by a few absorbable stitches. Administration of regular insulin was started just after the operation at the rete of 2 unit/hour for 2 to 3 weeks. Blood glucose level was maintained between 150 and 200mg/dL. In insulin therapy group(n=4), the AKBR of two patients recovered within a few hours after the operation, and that of the remaining 2 patients recovered on the first postoperative day But in the control group(n=5), none of the five cases had an AKBR of more than 0.7 on the day of operation. The AKBR returned to normal on the first postoperative day in 2 cases, on the second postoperative day in 1 case, and on the fifth day in 1 case. The AKBR recovery time was shorter in the intraportal insulin therapy group than in the control group(p=0.045). In conclusion, intraportal. insulin infusion after hepatectomy via the reopened umbilical vein may be a very simple and safe means of promoting recovery of remnant liver function after hepatectomy in hepatoma patients with insulinopenia.