腹腔镜局部切除治疗胰腺良性和低度恶性肿瘤28例临床体会

目的 探讨胰腺良性和低度恶性肿瘤行腹腔镜下保留器官功能的局部切除术的安全性和有效性。方法 回顾性分析华中科技大学同济医学院附属协和医院胰腺外科2020年7月至2021年12月行腹腔镜下胰腺局部切除术28例病人的临床资料。28例病人中,胰头肿物16例(腹腔镜下保留十二指肠的胰头切除术13例,腹腔镜下胰腺肿物剜除术3例),胰腺颈体肿物7例(腹腔镜下胰腺中段切除术6例,腹腔镜下胰腺肿物剜除术1例),胰体尾肿物5例(腹腔镜下保留脾脏的胰体尾切除术3例,腹腔镜下胰腺肿物剜除术2例)。观察病人术中出血量、输血量以及手术时间、术后并发症等情况。结果 所有病人均在腹腔镜下顺利完成手术,无中转开腹病例。手术时间为60～450 min,术中出血量为20～550 mL,肿瘤直径为2～8 cm。术后并发症：B级胰瘘6例,C级胰瘘1例(胰头肿物剜除术1例),腹腔感染2例,胆瘘2例,胃瘫1例,腹腔出血2例(胰头肿物剜除术1例,胰颈体肿物行胰腺中段切除术1例)。术后随访8个月,未发现继发性胰腺内外分泌功能障碍。病人平均住院时间为20.9 d。术后病检：胰腺实性假乳头状瘤8例,胰腺神经内分泌肿瘤G1级5例、G2级2例...     

腹腔镜手术在胰腺疾病中的临床应用探讨

目的探讨腹腔镜手术在胰腺疾病中的临床应用效果。方法对12例胰腺疾病患者施行腹腔镜手术,其中包括胰腺囊性疾病9例,分别行保留脾脏的胰体尾切除术(4例)、胰体尾加脾脏切除术(2例)及单纯胰腺囊肿切除术(3例);胰岛素瘤2例,均行胰岛素瘤切除术;胰腺癌术后复发1例,行左侧内脏神经离断术。结果所有手术均获成功,其中完全腹腔镜下手术8例,经腹腔镜辅助手术4例。平均手术时间225min(100～420min),平均出血量80ml(2～150ml);1例术后发生胰瘘,经保守治疗治愈;术后平均住院时间7.2d(5～13d)。胰腺癌术后复发患者术后存活6个月,止痛效果满意;其余患者随访10～36个月,效果良好,无复发。结论腹腔镜手术治疗部分胰腺疾病安全有效,具有创伤小、痛苦轻、恢复快、并发症少等优点,具有广阔的应用前景。     

腹腔镜手术治疗同时性胃肠道多原发癌的临床疗效

目的 探讨腹腔镜手术治疗同时性胃肠道多原发癌的安全性和可行性.方法 回顾性分析2009年1月至2014年1月中山大学附属第三医院19例行腹腔镜手术治疗同时性胃肠道多原发癌患者的临床资料.术后通过门诊或住院复诊、电话及信件方式随访,随访时间截至2014年4月或患者死亡.结果 19例患者手术顺利,其中腹腔镜辅助远端胃癌根治+直肠前切除术3例;腹腔镜辅助远端胃癌根治+胰十二指肠切除术1例;腹腔镜辅助右半结肠切除+胃体胃肠道间质瘤楔形切除术1例;腹腔镜辅助右半结肠切除+直肠前切除术4例;腹腔镜辅助左半结肠切除+直肠前切除术4例;腹腔镜辅助乙状结肠切除+直肠切除术6例.平均手术时间为228 min(145～ 380 min),辅助切口平均长度为5 cm(4～7 cm),术中平均出血量为86 mL(10～250 mL),无中转开腹患者.平均清扫淋巴结数目为39枚(21 ～58枚),平均阳性淋巴结数目为3枚(0～6枚).术后拔除腹腔引流管平均时间为3 d(2～6 d),术后恢复进食平均时间为4d(2 ～7 d),术后平均住院时间为10 d(7 ～21 d).术后并发切口感染1例,经对症处理后痊愈出院.患者术后平均随访时间为24个月(3 ～48个月),1例失访,12例无瘤生存,4例带瘤生存,2例因肿瘤相关原因死亡.结论 腹腔镜手术治疗同时性胃肠道多原发癌是安全、可行的,且具有创伤小、恢复快的优点.     

腹腔镜胰腺远端切除术治疗体会

目的探讨腹腔镜下胰腺远端切除术的手术适应证、安全性和可行性。方法选择2005年2月-10月住院的连续10例胰体尾占位患者,年龄(43．4±14．7)岁,男1例,女9例。9例术前诊断为囊性占位,肿瘤最大径平均4．0 cm(2．6～8．5cm);1例术前诊断为胰体尾病变伴肝转移,胰腺内分泌肿瘤可能性大。其中7例行保留脾脏胰腺远端切除术,3例行胰腺远端+脾切除术。结果10例手术均完全在腹腔镜下完成。手术时间(228±26)min,术中出血量(173±100)ml。术后胰瘘1例(10％),充分引流1个月后自行愈合;1例患者术后1个月复查发现胰腺断端旁有假性囊肿形成,直径约2 cm,观察1个月后囊肿消失。其余8例无并发症发生。术后平均住院13．5 d(12～16 d)。10例患者术后血糖均正常。10例随访2～22个月(中位数8个月),9例囊性病变患者均无复发,1例内分泌癌随访1年,肝脏转移病灶无明显变化,原发部位无肿瘤复发。结论对于病变位于胰体尾的良性肿瘤或疾病,选择腹腔镜胰腺远端切除术是安全、可行的。     

腹腔镜胰体尾切除术的临床应用(附4例报告)

目的探讨腹腔镜胰体尾切除术(laparoscopicdistalpancreatectomy,LDP)治疗胰体尾肿瘤的临床价值。方法2002年6月～2004年12月行LDP的患者4例(保留脾脏1例),平均年龄39.8岁(31～48岁)。其中胰腺体尾部实性占位2例,囊实性占位2例。结果手术均在全腹腔镜下一次成功,平均手术时间305min(95～465min),平均出血140ml(50～300ml)。1例发生胰漏,经保守治疗痊愈。术后平均住院9.8d(5～18d)。结论LDP创伤小、术后恢复快,是治疗胰体尾肿瘤安全、可行的方法。     

腹腔镜保留与不保留脾脏的胰体尾切除术治疗胰体尾病变的效果分析

目的:对比腹腔镜保留脾脏(LSPDP)与不保留脾脏的胰体尾切除术(LDPS)治疗胰体尾病变的临床效果。方法:分析2011年3月至2018年6月行腹腔镜胰体尾切除术的31例胰体尾占位患者的临床资料。按手术方式将患者分为保留脾脏的胰体尾切除组(LSPDP组,n=14)与脾脏切除组(LDPS组,n=17),对比两组患者围手术期及随访结果。结果:两组均无围手术期死亡病例。LSPDP组肛门排气时间、术后住院时间优于LDPS组,差异有统计学意义(P<0.05);两组术中出血量、手术时间、胰瘘发生率、门静脉血栓发生率、腹腔积液发生率差异无统计学意义(P>0.05)。31例患者术后随访6～81个月,平均(28.26±19.21)个月,无肿瘤复发转移。结论:由经验丰富的腹腔镜外科医生有选择性地行腹腔镜保留脾脏的胰体尾切除术治疗胰腺良性或交界性肿瘤是安全、可行的。     

腹腔镜保留脾脏胰体尾切除术17例报道

目的探讨腹腔镜保留脾脏胰体尾切除术的可行性及临床价值。方法回顾性分析2015年1月至2017年6月期间17例施行腹腔镜保留脾脏胰体尾切除术患者的临床资料。结果 17例患者均在腹腔镜下完成保留脾脏胰体尾切除术,按Kimura法完成12例,按Warshaw法完成5例。全组患者手术时间为(218±60)min,术中出血量为(136±114)m L,术后开始下床活动时间为(1.4±0.6)d,术后首次进流食时间为(2.0±0.8)d,术后住院时间为(13.4±5.7)d。术后发生生化漏3例,B级胰瘘3例。术后发生脾局灶性梗死2例。术后病理:胰腺浆液性囊腺瘤2例,黏液性囊腺瘤7例,实性假乳头状瘤3例,导管内乳头状黏液性肿瘤3例,胰岛素瘤2例。术后随访5~26个月,平均13个月,无肿瘤复发,未发现脾梗死,发现胃周静脉曲张1例,但未破裂出血。结论腹腔镜保留脾脏胰体尾切除术安全、可行、创伤小及恢复快。     

经后腹腔途径腹腔镜下肾上腺腺瘤切除术中胰腺损伤3例分析

目的 回顾总结经后腹腔途径腹腔镜下肾上腺腺瘤切除术中胰腺损伤的处理经验.方法 从2006年1月～2011年1月,本院共施行经后腹膜腹腔镜下肾上腺腺瘤切除手术113例,其中胰腺损伤3例,发生率约2.6％.男性1例,女性2例,平均年龄48.5岁(41～ 56岁).3例胰腺损伤均发生于左侧,3例为肾上腺腺瘤.损伤部位均位于胰尾部,其中横断伤1例,撕裂伤2例.1例采用开放手术处理胰腺断面,其余2例采用腔镜钛夹或endo - GIA夹闭胰尾或分支胰管,创面给予强生止血纱布压迫,留置引流管.术后常规禁食、胃肠减压、静脉滴注生长抑素以及静脉营养等.结果 3例患者术后平均血、尿和引流液淀粉升高,分别为(632±237.5)U、( 1373.6±432.1)U和(1458.2±453.7)U.患者恢复顺利.平均引流管留置时间18.5d(10d～27d),平均住院25.6d(15d～36d).3～6个月后随访未发现胰腺异常.结论 经后腹膜腹腔镜下肾上腺腺瘤切除术中胰腺损伤主要发生于胰尾部.术中应及早发现和妥善处理,损伤严重者应及时采用开放.对于轻微撕裂伤应在采用腔镜钛夹或endo - GIA夹闭胰尾或分支胰管的情况下保持引流管通畅可以有效地治疗胰腺损伤.     

全腹腔镜下保留脾脏胰体尾切除术在儿童病例中的应用

目的探讨完全腹腔镜下保留脾脏胰体尾切除术在治疗儿童胰体尾良性、交界性肿瘤中的安全性、可行性及疗效。方法回顾性分析2017年6月至2018年3月十堰市太和医院收治的3例儿童胰体尾肿瘤患儿(年龄分别为10岁、9岁、12岁)行完全腹腔镜下保留脾脏胰体尾切除术的临床资料。结果 3例患儿均在全腹腔镜下完成保留脾脏胰体尾切除术,1例采用Warshaw法,2例采用Kimura法,手术时间分别为210 min、180 min、210 min,术中出血量分别为200 mL、50 mL、50 mL,术后平均住院时间为11 d, 3例患儿术后病理诊断均为胰腺实性假乳头状瘤,术后均无再次手术,无腹腔出血、消化道出血、胃瘫等并发症发生,其中1例术后并发A级胰瘘,经积极保守治疗后治愈。术后随访31～40个月,效果良好,无肿瘤复发,均未出现糖尿病和慢性腹泻等并发症。结论对于儿童胰体尾良性、交界性肿瘤,腹腔镜下保留脾脏的胰体尾肿瘤切除术是相对安全、有效、可行的,具有创伤小、恢复快等优势,保留脾脏可使患儿更多获益,值得在儿童病人中选择应用。     

腹腔镜胰腺手术常见并发症分析

目的:探讨腹腔镜胰腺手术的常见并发症及其防治。方法:回顾分析2003年3月至2010年3月为56例患者施行腹腔镜胰腺手术的临床资料。2例未找到病灶而终止手术,54例完成手术,其中完全腹腔镜手术46例,中转开腹8例。手术方式包括肿瘤局部切除术25例,胰体尾、脾切除术23例(保留脾脏7例),保留幽门胰十二指肠切除术1例,真性囊肿开窗引流术3例,假性囊肿空肠吻合术2例(联合肝左外叶切除),联合腹腔镜胆囊切除术4例。结果:术中并发症包括中转开腹8例及脾静脉破裂出血2例。术后并发症包括2次手术3例,胰瘘19例。19例胰瘘包括A级12例,B级3例,C级4例,均经非手术方法治愈。术后住院4～31d,平均(10.5±6.2)d。结论:腹腔镜胰腺手术并发症发生率较高,其中出血和胰瘘是最常见的并发症。选择适当的手术方法可降低其发生率,术后早期发现和正确处理胰瘘可预防腹腔感染和继发出血。     

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.