TOTAL PARENTERAL-NUTRITION IN POSTHEPATECTOMY PATIENTS

Blood biochemical and nutritional metabolism indices were examined in eight patients who received infusion containing glucose, fructose, and xylitol in a 4:2:1 ratio (group GFX) after liver resection compared with those in six patients who received only glucose (group G). Preoperative patient-selection criteria consisted of a parabolic oral glucose tolerance test level over time, a total activity of coagulation factors II, VII, and X of greater-than-or-equal-to 60%, and an indocyanine green disappearance rate (ICG K) of greater-than-or-equal-to 0.13. Total parenteral nutrition (TPN) was started on the 3rd postoperative day. Levels of blood biochemical indices, rapid-turnover proteins, and urinary 3-methylhistidine were measured, and amino acids and nitrogen balance were analyzed preoperatively and on the 2nd, 5th, and 7th postoperative days. In group GFX, serum glutamic oxaloacetic transaminase and glutamic pyruvic transaminase levels decreased soon after TPN was begun, being 47 +/- 8 and 84 +/- 14 U/L, respectively, on the 7th postoperative day. This level was significantly lower (p < 0.05) than that in group G on the same day (94 +/- 18 and 141 +/- 22 U/L, respectively). There was no difference between the two groups in levels of rapid-turnover proteins or in Fischer ratio of amino acids. Urinary 3-methylhistidine level decreased soon after TPN in group GFX. Nitrogen balance became positive on the 7th postoperative day in group GFX, whereas it remained negative until the 7th postoperative day in group G. We conclude that infusion containing a 4:2:1 ratio of glucose, fructose, and xylitol is more useful in the postoperative care of patients who have undergone liver resection than infusion containing glucose alone.