原发肢体软组织肉瘤208例预后的影响因素分析

目的 探讨影响肢体软组织肉瘤预后的因素,特别是外科治疗对其预后的影响.方法 回顾性研究208例手术治疗的肢体软组织肉瘤患者,其中男性128例,女性80例,平均年龄46岁(9～98)岁.分析患者是否初治、肿瘤的大小(＜5 cm、5～10 crn、＞10 cm)、深度(深筋膜深层、浅层)、组织学分型(脂肪肉瘤、恶性纤维组织细胞瘤、滑膜肉瘤、纤维肉瘤、恶性神经鞘瘤、其他肿瘤)、病理分级(FNCLCC系统Ⅰ、Ⅱ、Ⅲ级)、外科边界(囊内切除、边缘切除、广泛切除、根治切除)以及辅助治疗等因素对患者预后的影响.结果 中位随访时间37.5个月(1.3 ～ 128.1个月),总体3年、5年生存率77％和75％;复发率28％和37％;转移率35％和43％.肿瘤大小、病理分级和术前是否有转移可以独立影响生存率(x2=18.813、24.849、21.107,均P＜0.05);是否为初治病例、组织学分型可以独立影响复发率(x2=21.915、12.192,P＜0.05);病理分级可以独立影响转移率(x2=7.714,P＜O.05).手术外科边界可以独立影响局部复发率和转移率(x2=19.610、9.272,P＜0.05).结论 外科边界独立影响局部复发率和远处转移率,从而间接影响生存率.尤其对无转移的初次治疗的软组织肉瘤,手术是首选方案,手术外科边界达到广泛切除或根治性切除将明显改善患者的预后.     

骨原发尤文肉瘤预后相关因素的分析

目的 明确骨原发尤文肉瘤患者的治疗结果,分析影响预后相关因素.方法 回顾性分析1998年7月至2007年7月就诊的78例骨原发尤文肉瘤患者的临床资料.通过随访了解肿瘤学预后,明确5年总体生存率及局部复发率.通过回顾病例,分析年龄、性别、肿瘤部位、肿瘤大小、初次诊断时有无转移、乳酸脱氢酶、碱性磷酸酶水平、治疗方式、外科边界等因素对总体生存率的影响.利用Kaplan-Meier生存分析确定对生存有影响的单个因素,并通过Cox回归分析明确影响预后的独立危险因素.结果 53例患者获得随访,中位随访时间37.6个月(8.0～101.0个月).患者5年总体生存率为33.7%,局部复发率20.8%,中位复发时间20个月.单因素分析结果显示:年龄＜20岁、初诊时元转移、病变位于四肢、肿瘤直径＜10 cm、取得广泛外科边界的患者预后较好(P＜0.05);多因素分析显示初诊时转移情况、肿瘤部位、肿瘤直径是影响预后的独立危险因素.结论 初诊时有无转移、肿瘤的部位和大小是影响骨尤文肉瘤预后的独立危险因素.     

无转移肢体软组织肉瘤非计划性手术后再次手术的临床相关因素研究

背景:软组织肉瘤是一组包含50余种亚型的恶性肿瘤,手术彻底切除肿瘤是治疗无转移肢体软组织肉瘤的主要手段。如果初次进行了非计划性手术,后期治疗更加困难。目的:评价无转移肢体软组织肉瘤患者接受非计划性手术后再次手术时需要进行软组织修复重建的比例以及患者的预后情况。方法:回顾性分析2016年10月至2019年4月手术治疗的28例无转移肢体软组织肉瘤患者的资料,其中11例接受非计划性手术后再次手术,17例行计划性手术组。记录两组的软组织修复重建率、局部复发率、远处转移率及无瘤生存率等指标。观察终点为术后肿瘤复发、转移或非肿瘤引起的死亡。结果:所有患者均顺利完成手术治疗。非计划性手术后再次手术组软组织重建率为27.3%,高于计划性手术组的11.8%,但差异无统计学意义(P>0.05)。随访时间1~36个月,平均(16.3±9.3)个月。随访期间再次手术组肿瘤局部复发率、远处转移率和无瘤生存率分别为18.2%、9.1%、72.7%,计划性手术组上述指标分别为5.9%、11.8%、82.3%,两组比较差异均无统计学意义(P>0.05)。多因素分析结果表明手术方式为患者无瘤生存的独立风险因子(P<0.05)。结论:无转移的肢体软组织肉瘤接受非计划性手术后再次手术,短期内患者的预后不会受到初次手术的影响,但再次手术时需要进行软组织修复重建的可能性会增大。     

滑膜肉瘤预后相关因素分析

目的 分析影响滑膜肉瘤患者预后的相关因素.方法 回顾性分析1997年9月至2008年9月就诊的66例滑膜肉瘤患者中52例获得随访的患者的临床资料.其中男性28例,女性24例;发病年龄11～71岁,均以无痛性肿块入院.通过随访了解肿瘤学预后,明确3、5年总体生存率及局部复发率.通过回顾病例,分析年龄、性别、肿瘤部位、肿瘤直径、外科边界、病理亚型、局部治疗方式、是否侵及骨与神经血管以及是否化疗9项因素对总体生存率的影响.利用Kaplan-Meier生存分析确定对生存有影响的单个因素,并通过Cox回归分析明确影响预后的独立危险因素.结果 52例患者获得随访,随访率78.8％;随访时间6 ～ 88个月,中位随访时间32个月.患者5年总体生存率为30.3％,局部复发率为32.7％,中位复发时间16个月.单因素分析结果提示:肿瘤直径＜5 cm、取得广泛外科边界、肿瘤位于四肢以及采取广泛切除联合局部放疗的患者预后较好(P＜0.05).多因素分析显示肿瘤直径,部位以及是否取得广泛外科边界是影响预后的独立危险因素.结论 肿瘤直径、部位以及是否取得广泛外科边界是影响预后的独立危险因素.     

透明细胞肉瘤的治疗及疗效分析

目的探讨透明细胞肉瘤的临床特点及治疗方法,分析治疗效果及影响因素。方法对1990年6月至2004年7月收治的17例透明细胞肉瘤进行回顾性分析。男8例,女9例;年龄12￣73岁,平均36.8岁。14例曾于外院行局部切除术,10例复发,2例有区域淋巴结转移。发病部位:足5例,上肢6例,下肢1例,躯干5例。肿瘤大小在5cm以上者6例,小于5cm者11例。17例中15例行手术治疗,2例放疗;联合使用化疗13例。手术方式包括间室切除2例,广泛切除12例,截趾1例。联合淋巴结清扫术4例,清扫后截肢1例。结果所有患者随访5￣89个月,平均31.5个月。15例行手术治疗者中1例局部复发。17例中9例出现区域淋巴结转移,转移率为52.9%;7例远隔转移,其中肿瘤大小在5cm以上者6例。死亡6例,存活11例,其中1例为带瘤存活。2年生存率为84%,5年生存率为36%。结论透明细胞肉瘤比较罕见,恶性度高,预后差。首次规范的手术治疗是治疗成败的关键,肿瘤大小是影响预后的重要因素。肿瘤大小、是否复发与是否发生转移关系密切,淋巴结转移与血行转移者预后差。放、化疗的疗效尚需进一步研究。     

腺泡状软组织肉瘤外科治疗的预后分析

 目的 探讨腺泡状软组织肉瘤的临床特点与外科治疗的预后相关因素。方法 回顾性分析1982年1月至2010年10月期间资料完整的腺泡状软组织肉瘤29例,男18例,女11例;年龄9~58岁,平均24.4岁,中位年龄21岁。最终接受手术治疗的26例纳入研究,软组织为首发23例,骨首发3例。临床表现主要为局部的无痛性肿块17例（65.4%,17/26）,伴有疼痛症状9例（36.4%,9/26）。纳入分析的指标包括性别、年龄、肿瘤体积、Enneking外科分期、外科边界以及辅助化疗与否。肿瘤学评价包括局部复发率、转移率和生存分析。肿瘤体积与外科边界对局部复发率、辅助化疗对转移率的影响采用单因素分析;多因素分析局部复发率采用Logistic回归分析;生存因素采用Cox回归分析。结果 Enneking外科分期Ⅱ期14例,Ⅲ期12例。手术行边缘切除9例、广泛切除17例。随访时间5~226个月,平均45.9个月,中位随访时间为31个月,最终12例存活（46.2%）。Ⅱ期和Ⅲ期病例五年生存率分别为79.5%和23.4%。局部复发7例（26.9％）,广泛切除与边缘切除复发率的差异有统计学意义。Ⅱ期患者接受与未接受化疗转移发生率的差异无统计学意义。肿瘤直径>5 cm和< 5 cm的患者五年生存率分别为40.7%和80.0%。Logistic回归分析显示外科边界与局部复发率明显相关,Cox回归分析表明Enneking外科分期和肿瘤体积是死亡的独立预后因素。结论 腺泡状软组织肉瘤典型表现为无痛包块,易发生早期转移;外科边界是局部复发率的独立预后因素;Enneking外科分期与肿瘤体积是影响生存的独立危险因素;辅助化疗对于控制新发转移率和提高生存率的无明显改善。     

早期胃癌临床病理学特征与预后的关系

目的:探讨和总结早期胃癌的临床病理学特征及其与病人预后间的关系,分析早期胃癌的淋巴结转移规律,为微创治疗、缩小手术提供依据。方法:采用单因素及多因素的分析法,回顾分析2003年1月至2008年9月仁济医院普外科接受手术治疗的231例早期胃癌病人的临床及病理学资料。结果:单因素分析显示,肿瘤大小、浸润深度及淋巴结转移程度与早期胃癌的预后相关;多因素分析提示,淋巴结转移是早期胃癌预后的独立性危险因素。单发早期胃癌的淋巴结转移率为15.6%(36/231),黏膜内癌淋巴结转移率为5.7%(4/70),黏膜下癌淋巴结转移率为19.9%(32/161)。Logistic回归分析提示,肿瘤直径>2 cm(P=0.038,OR=1.351)和肿瘤浸润至黏膜下层(P=0.027,OR=3.635)是淋巴结转移的独立危险因子。本研究中,无淋巴结转移的早期胃癌病人,其术后3年生存率为98.6%,显著优于有淋巴结转移者(P2 cm、肿瘤浸润至黏膜下层是早期胃癌淋巴结转移的独立危险因子;术前应用影像学技术评估早期胃癌淋巴结转移情况有助于选择合理的治疗方案。     

胃平滑肌肿瘤的诊断和外科治疗

目的 探讨胃平滑肌肿瘤的诊断及治疗方法。方法 对34例经手术治疗的胃平滑肌肿瘤的临床资料进行回顾性分析。结果 胃平滑肌肉瘤肿块较大，本组中最大直径≥5cm者占68％，≥10cm者占50％；胃平滑肌肉瘤大多位于胃底体区，占94％；胃平滑肌肉瘤有三大临床表现：上腹痛、上腹包块、出血。胃镜、钡剂X线透视、CT有助于诊断。随访结果：本组3、5、10年生存率分别是87％、52％及26％。结论 对胃平滑肌肉瘤应积极考虑手术治疗。根据肿块大小、部位和浸润程度决定手术方式。     

肿瘤大小与早期胃癌预后的关系

目的 探讨早期胃癌的预后因素,特别是肿瘤大小与早期胃癌预后的关系.方法 回顾性分析1998年1月至2002年2月119例在中国医学科学院肿瘤医院外科治疗的早期胃癌的临床病理特征,分析早期胃癌的预后因素.结果 本组早期胃癌病例5年生存率为90.9%,其预后主要与肿瘤大小相关,直径＜2 cm组、2 cm≤直径＜4 cm组与直径≥4 cm组5年生存率分别为100%、92.0%、80.8%,差异有统计学意义,P=0.024.同时比较淋巴结转移及浸润深度等因素,P值分别为0.816及0.371,差异无统计学意义.肿瘤大小与其他预后因素之间无明显相关性.结论 早期胃癌浸润深度及淋巴结转移与其预后关系不明确,而肿瘤大小很可能是早期胃癌独立的预后因素,对指导早期胃癌预后及手术选择有实用价值.     

胰腺癌辅助治疗的若干热点问题

胰腺癌恶性程度高,死亡率高达98%。虽在新发恶性肿瘤中胰腺癌所占比例不足3%,但因其生物学行为具有侵袭性且早期缺乏特异性症状和体征,约85%的病人确诊时已处于进展期而无法手术切除。在美国,胰腺癌的死亡率居恶性肿瘤第4位,总体5年生存率仅为5%。手术是胰腺癌最有效的治疗方法,获根治性切除并联合辅助治疗的病人5年生存率为23.4%,但可获根治性切除者不足15%。肿瘤大小、淋巴结转移、胰腺外神经侵犯是决定胰腺癌预后的主要因素,肿瘤直径〈1cm、无淋巴结浸润者预后较好。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.