Effect of the herbal medicine Dai-kenchu-to for serum ammonia in hepatectomized patients.
OBJECTIVE
Prolonged paralytic ileus occurring in hepatectomized patients may induce hyperammonemia or bacterial translocation, which injures the remnant liver function and sometimes causes post-resection liver failure. We examined the effectiveness of the herbal medicine, Dai-kenchu-to (DKT), on postoperative serum ammonia levels in patients with liver resection and compared it with lactulose.


METHODS
Patients with liver resection were divided into three groups. Lactulose group (n=31), 16g of lactulose was administered orally three times a day from the first postoperative day. DKT group (n=27), 5g of DKT was administered in the same fashion. Control group (n=26), neither lactulose nor DKT was administered. In all three groups, 16g of lactulose was administered three times a day for three days preoperatively.


RESULTS
There was no significant difference among the groups in age, gender and preoperative hepatic functional values, such as ICG-R15 or galactose tolerance test. There was also no difference in parenchymal hepatic resection rate, operative time and amount of intraoperative bleeding volume. Postoperative serum ammonia levels were significantly lower in the DKT group than control and lactulose groups. Instances of delayed flatulence and occurrence of diarrhea were also fewer in the DKT group.


CONCLUSIONS
DKT may become a more effective and safe agent than lactulose in postoperative management of liver resection.
Kaiho
Takashi
T
Department of Surgery, Kimitsu Chuo Hospital, Chiba University, Graduate School of Medicine, Chiba, Japan. kaihot@aa.pial.jp
Tanaka
Toshikazu
T
Tsuchiya
Shunichi
S
Yanagisawa
Shnji
S
Takeuchi
Osamu
O
Miura
Masami
M
Saigusa
Naoki
N
Miyazaki
Masaru
M
D000368:Aged; D000641:Ammonia / Q000097:blood*; D004334:Drug Administration Schedule; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000494:pharmacology; D006498:Hepatectomy; D006801:Humans; D007792:Lactulose / Q000008:administration & dosage / Q000494:pharmacology; D008107:Liver Diseases / Q000097:blood* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D005894:Panax; D010936:Plant Extracts / Q000008:administration & dosage / Q000494:pharmacology*; D011184:Postoperative Period; D032106:Zanthoxylum; D030521:Zingiberaceae
D004365:Drugs, Chinese Herbal; D005765:Gastrointestinal Agents; D010936:Plant Extracts; C121414:dai-kenchu-to; D007792:Lactulose; D000641:Ammonia