Prevention of postoperative complications in jaundiced rats. Internal biliary drainage versus oral lactulose.

In an experiment mimicking a severe surgical trauma by deliberate renal ischemia, the postoperative outcome in jaundiced rats was studied. Intervention studies were performed with preoperative oral lactulose (to reduce endotoxin toxicity) or preoperative internal biliary drainage. Compared to control, obstructive jaundice in rats significantly reduced survival time (p less than 0.001) and enhanced renal impairment (p less than 0.001) after renal ischemia. Preoperative supportive therapy of jaundiced rats with oral lactulose increased survival time (p less than 0.01) but did not reduce deterioration of renal function. Preoperative internal biliary drainage proved to be superior, with a significant reduction of renal impairment (p less than 0.001) and an improved survival time (p less than 0.001). Our experiments provide further evidence that obstructive jaundice increases the complication rate following major surgical procedures. Based on our results in rats, we suggest that in obstructive jaundice preoperative internal biliary drainage is the supportive therapy of choice. However, if adequate drainage is not possible, oral treatment with lactulose may help reduce postoperative complications.     

恶性梗阻性黄疸时内毒素血症,肾功能损害及乳果糖治疗的临床研究

观察了３２例恶性梗阻性黄疸病人内毒素血症（ＥＴＭ）发生率及其与肾功能损害的关系．并对乳果糖对ＥＴＭ的治疗作用进行了随机性、前瞻性研究。治疗组术前１ｄ周围静脉血ＥＴＭ发生率为４１．２％．对照组为５３．３％（Ｐ＞０．０５）；术中分别为４７．１％及６０％（Ｐ＞０．０５）；术后ｄ３分别为４１．２％及８０％（Ｐ＜０．０５）．治疗组门静脉血ＥＴＭ发生率为４７．１％，对照组为８６．７％（Ｐ＜０．０５）。乳果糖治疗组无术后肾衰；对照组１例肾衰并死亡．乳果糖治疗组发生术后肾功能损害１例（５．９％），对照组５例（３３．３％）．Ｐ＝０．０６２．结果显示，恶性梗阻住黄疸病人术后肾功能损害的发生与ＥＴＭ密切相关．在梗阻未解除、高胆红素血症的状态下，术前口服乳果糖可明显降低门静脉及术后周围静脉血ＥＴＭ发生率．保护肾功能。     

Prevention of postoperative renal dysfunction in patients with obstructive jaundice: a multicentre study of bile salts and lactulose

The role of preoperative lactulose and bile salts in the prevention of postoperative renal failure in patients with obstructive jaundice has been evaluated in a prospective randomized trial. One hundred and two patients undergoing surgery for obstructive jaundice (bilirubin greater than 100 mumols/l) were randomized into three groups: those receiving preoperative oral lactulose (n = 35), those receiving oral sodium deoxycholate (n = 32) and a control group of patients receiving no specific treatment (n = 35). All patients received intravenous fluids commencing the night before surgery. One patient in the control group and none in the treatment groups developed postoperative renal failure. Postoperative deterioration of renal function in patients with normal preoperative function was significantly more common in the control group than in the treatment groups (chi 2 = 8.1, d.f. = 2, P less than 0.02). The incidence of renal failure and impairment was lower in this control group than that reported in previous studies. This may be due to the introduction of adequate preoperative hydration. Additional protection occurs by the preoperative administration of either lactulose or sodium deoxycholate.     

A randomized clinical trial of oral ursodeoxycholic acid in obstructive jaundice

Forty patients with obstructive jaundice (bilirubin greater than 100 mumol/l) were entered into a randomized trial of oral ursodeoxycholic acid for 48 h before surgery versus no additional therapy. Pre-operative venous and operative portal total bile salt concentrations were higher in the bile salt treated patients (P less than 0.001). Portal endotoxaemia during operation was reduced in ursodeoxycholic acid treated patients (P less than 0.05). There was no significant difference in systemic venous endotoxaemia, renal function or postoperative morbidity or mortality. This study suggests pre-operative oral bile salt therapy may be of no clinical benefit in patients with obstructive jaundice.     

Prevention of postoperative renal failure in patients with obstructive jaundice--the role of bile salts

Preoperative administration of the simple bile salt sodium deoxycholate has been shown in this study to prevent postoperative endotoxaemia and renal failure in patients with obstructive jaundice. Fifty-four per cent of jaundiced patients not given the salt were found to have systemic endotoxaemia, associated with renal impairment in two-thirds of the cases. No patient given sodium deoxycholate 500 mg 8 hourly for 48 hours before operation had portal or systemic endotoxaemia, and none had evidence of renal impairment (P less than 0 X 02, X2 with Yates' correction). The incidence of endotoxaemia in untreated jaundiced patients was very significantly greater than in non-jaundiced patients undergoing elective upper abdominal surgery (P less than 0 X 005), but this difference is abolished by the prophylactic administration of the oral bile salt. The mechanism of action of bile salts in preventing endotoxin absorption from the small bowel has been investigated, and the lack of any significant alteration in the small bowel microbial flora in obstructive jaundice suggests that a direct effect on the endotoxin molecule is involved. Nearly 20 per cent of patients with obstructive jaundice still develop postoperative renal insufficiency, but preoperative prophylactic use of sodium deoxycholate should reduce this very significantly.     

内毒素引起阻塞性黄疸大鼠肾功能障碍的机制

目的 探讨阻塞性黄疸(obstructive jaundice,OJ)时内毒素引起肾功能障碍的机制.方法 SD大鼠60只,胆总管结扎后,分5 d(B1),10 d(B2),15 d(B3)三组,每组各10只,同时建立相应对照组(A1,A2,A3),另30只胆总管结扎后分3组(SHUD,LAC,NS),每组各10只,分别用2 ml舒胆合剂、乳果糖液、生理盐水灌胃,连用9 d.观察内毒素、血和肾组织中内皮素(endothelin,ET)、一氧化氮(nitric oxide,NO)的含量、一氧化氮合酶(nitric oxide synthase,NOS)活性及肝、肾功能的变化.结果 血内毒素与血、肾组织ET含量,ET/NO比值呈显著正相关(P＜0.05,r=0.630,0.438,0.496,0.453),与肌肝清除率(creatinine clearance,Ccr)和肾皮质血流量(renal cortical blood flow,BCBF)呈显著负相关(P＜0.05,r=-0.600,-0.410).血、肾组织ET/NO比值与Ccr,RCBF呈显著负相关(P＜0.05,r=-0.449,-0.558,-0.626,-0.731).血和肾组织内NO水平与内毒素水平呈负相关(P＜0.05,r=-0.518,-0.441),与Ccr、RCBF呈正相关(P＜0.05,r=0.422,0.496,0.400,0.659).SHUD组与LAC血内毒素、ET水平组明显降低,血和肾组织NO,NOS活性以及Ccr,RCBF较NS组明显升高.结论 OJ时内毒素可通过刺激ET的释放,提高ET/NO比值,使肾内缩血管因子与扩血管因子比例失调而损伤肾功能.     

Endotoxemia,disturbance of coagulation,and obstructive jaundice

A prospective study of coagulation disturbances and endotoxemia in 42 patients having major pancreatic or biliary surgery was performed. Endotoxin, soluble fibrin, and fibrin degradation products were measured before and after operation in 28 patients with obstructive jaundice and in 14 nonjaundiced controls. In the control group there was one death and no unexplained fever or postoperative hemorrhage. The jaundiced group had more complications: seven deaths, nine episodes of fever, and six episodes of hemorrhage. Soluble fibrin was detected only in patients with obstructive jaundice, in whom it occurred in 38 percent before operation. Positive endotoxin assay was as common in control patients as in the jaundiced group, but in the latter endotoxin was associated (p < 0.05) with increased FDP and soluble fibrin. Patients with endotoxin or increased FDP levels before operation for jaundice carry a poor prognosis (7 of 11 died). Preoperative bowel preparation in 16 of the jaundiced patients did not affect the outcome.     

Effect of Oral Glutamine Administration on Bacterial Tanslocation, Endotoxemia, Liver and Ileal Morphology, and Apoptosis in Rats with Obstructive Jaundice

Postoperative complications in patients with obstructive jaundice remain increased when associated with endotoxemia and the inflammatory response due to gut barrier failure. Administration of glutamine has been proposed to maintain the integrity of the gut mucosa and thus reduce bacterial translocation (BT), but the effects of this pretreatment on apoptosis and histologic morphology of various organs affected by BT in obstructive jaundice have not been studied. We therefore studied the effects of oral glutamine supplementation on endotoxemia, BT, liver and terminal ileal morphology, and apoptosis in an experimental model of obstructive jaundice. A total of 60 male Wistar rats were randomly divided into four groups of 15 each: I, controls; II, sham-operated; III, bile duct ligation (BDL); IV, BDL + glutamine (4.5 g/kg/day in drinking water). Ileal samples for histology, DNA and protein content, liver biopsies, mesenteric lymph nodes (MLNs) for culture, and portal and systemic blood samples for endotoxin measurements were obtained 10 days later. Compared to the controls, a significant increase in contaminated MLN and liver samples and increased endotoxemia were noted in group III (p < 0.01) but were significantly reduced in group IV (p < 0.05). Group IV also had a significantly higher number of mitoses per crypt (M/c) (p < 0.05), less apoptotic body counts (ABCs) (p < 0.05), and a higher DNA content than did group III (p < 0.05). Liver biopsies from group III displayed typical changes of large duct obstruction that significantly improved after glutamine treatment, with decreased ductular proliferation. We concluded that supplementation of oral glutamine in the presence of obstructive jaundice ameliorates BT, endotoxemia, and apoptosis and improves the ileal and liver histology.     

重组人生长激素在梗阻性黄疸的临床应用

目的　观察重组人生长激素 (rhGH)应用于梗阻性黄疸术后的治疗作用。方法　将 48例患者随机分为对照组 3 0例和rhGH组 18例 ,从术后第 1天开始 ,rhGH组皮下注射rhGH ,8U/d ,连续 7d ,与此同时对照组注射相同剂量的生理盐水。两组患者都给予肠道外营养支持治疗到能进食、水为止。并分别于术前、术后 1d、7d及 14d测定患者的生化全套、内毒素、肿瘤坏死因子及可溶性白细胞介素 2受体水平 ,并观察患者营养状况的改变。结果　术后 4drhGH组体重开始增加 ,术后 7d ,对照组体重也开始增加 ,但rhGH组比对照组体重增加明显。术后 7d ,rhGH组比对照组血糖升高 (P<0 .0 5 )。术后 7d ,rhGH组的血清白蛋白、转铁蛋白、前白蛋白比对照组升高 (P<0 .0 5 ) ;总胆汁酸、血清总胆固醇及低密度脂蛋白、血清谷草转氨酶、γ 谷氨酰转移酶、总胆红素、内毒素、肿瘤坏死因子及可溶性白细胞介素 2受体水平比对照组明显降低 (P<0 .0 1)。肾功能以及电解质两组变化无明显差异。结论　rhGH应用于梗阻性黄疸术后能改善机体的营养状况以及免疫功能。     

Measurement of operative plasma endotoxin levels in jaundiced and non-jaundiced patients

A study of portal plasma endotoxin levels was performed using a chromogenic limulus amoebocyte lysate (LAL) assay. The assay proved sensitive and reproducible. In only 1 of 25 healthy subjects was the systemic plasma endotoxin level above 100 pg/ml (equivalent Escherichia coli 0111B4). In 30 non-jaundiced patients undergoing surgery the mean (+SEM) portal plasma endotoxin level (60 + 9 pg/ml) was significantly higher (p less than 0.05) than the mean level in the systemic blood (46 + 6 pg/ml), supporting the concept of endotoxin absorption from the intestine into the portal blood. In 20 patients with obstructive jaundice undergoing surgery 42% of portal, 45% of inferior mesenteric and 35% of systemic venous plasma endotoxin levels were above 100 pg/ml. There were significantly higher levels in the portal (p less than 0.05) and inferior mesenteric (p less than 0.05) compared with the systemic blood. Neither the presence of malignancy nor the duration of surgery appeared to influence endotoxin absorption. The significance of raised plasma endotoxin levels in obstructive jaundice is discussed.     

舒胆合剂防治阻塞性黄疸肾功能障碍的作用机制

目的 探讨在阻塞性黄疸(OJ)时舒胆合剂的抗内毒素及对肾功能的保护作用。方法 SD大鼠胆总管结扎后分3组，每组10只，分别用2mL舒胆合剂、乳果糖液(每100mL含乳果糖67g)、生理盐水灌胃，连用9d。假手术组10只，用2mL生理盐水灌胃。观察内毒素、血和肾组织中内皮素(ET)、一氧化氮(NO)的含量、一氧化氮合酶(NOS)活性及肾功能的变化。结果 舒胆合剂组与乳果糖组血内毒素、血和肾组织ET水平较生理盐水组明显降低，血和肾组织N0、NOS活性、内生肌酐清除率、肾皮质血流量较生理盐水组明显升高。结论 在OJ时，中药舒胆合剂有抗内毒素作用，并通过减少体内内毒素水平来降低体内ET水平，升高N0水平起到保护肾功能的作用。     

梗阻性黄疸时脾切除对肠黏膜屏障影响的实验研究

目的 探讨脾脏在梗阻性黄疸(阻黄)中对肠黏膜屏障的作用及其机制.方法 50只Wistar大鼠随机分组,阻黄组开腹结扎胆总管;阻黄+脾切除组,同时切除脾脏.术后7d观察血浆内毒素水平的变化,用乳果糖/甘露醇(L/M)比值检测肠黏膜通透性;采用免疫组织化学、Western印迹检测末端回肠紧密连接蛋白闭锁小带-1(ZO-1)、闭锁蛋白的表达,并利用图像分析系统对Western印迹图像进行定量分析.结果 阻黄+脾切除后L/M的比值和血浆内毒素水平较阻黄组明显下降(均P=0.001).与阻黄组相比,阻黄+脾切除组的平均肠绒毛高度和隐窝深度有所上升(P=0.019、0.001).免疫组化显示术后7 d阻黄组ZO-1蛋白强阳性表达数(6/18)下降明显(P=0.021),阻黄+脾切除组(8/17)染色较阻黄组变化不大;闭锁蛋白的染色阻黄+脾切除组强阳性表达(7/17)高于阻黄组(4/18)(P=0.026).通过对Western印迹图像进行定量分析也得出同样的结论.结论 阻黄后肠黏膜通透性增加,肠黏膜屏障受损.同时切除脾脏,肠紧密连接蛋白成分的数量和分布改变,肠黏膜屏障的损害减轻.     

三种姑息减黄手术治疗恶性梗阻性黄疸临床对比分析

目的：比较不同姑息减黄手术治疗恶性梗阻性黄疸的临床效果。 方法：回顾性分析2007年1月—2012年1月期间收治的37例恶性梗阻性黄疸需姑息减黄患者临床资料,其中14例行经典Roux-en-Y胆肠吻合术式（经典内引流组）,12例行改良胆肠襻式吻合术（改良内引流组）,11例行体外胆汁转流术（外引流组）。比较3组的减黄疗效、术中与术后指标及生存情况。 结果：3组术后总胆红素水平均较术前明显下降,但3种术式的减黄效果相近（P>0.05）。改良内引流组和外引流组较经典内引流组手术时间、术中出血量、肠功能恢复时间及术后住院时间均明显减少,外引流组的住院费用少于经典内引流组与改良内引流组,手术时间、出血量较改良内引流组更加减少（均P<0.05）。经典内引流组术后2例（14.2%）发生反流性胆管炎,而改良内引流组和外引流组无反流性胆管炎发生。3组术后中位生存期差异无统计学意义（P>0.05）。 结论：改良胆肠襻式吻合术治疗恶性梗阻性黄疸疗效确切,术后器官功能恢复快,可以作为姑息减黄的首选术式,而体外胆汁转流术操作简单,创伤小、费用低,适于在基层医院推广。

     

梗阻性黄疸时脾切除对肠黏膜屏障影响的实验研究

目的 探讨脾脏在梗阻性黄疸(阻黄)中对肠黏膜屏障的作用及其机制.方法 50只Wistar大鼠随机分组,阻黄组开腹结扎胆总管;阻黄+脾切除组,同时切除脾脏.术后7d观察血浆内毒素水平的变化,用乳果糖/甘露醇(L/M)比值检测肠黏膜通透性;采用免疫组织化学、Western印迹检测末端回肠紧密连接蛋白闭锁小带-1(ZO-1)、闭锁蛋白的表达,并利用图像分析系统对Western印迹图像进行定量分析.结果 阻黄+脾切除后L/M的比值和血浆内毒素水平较阻黄组明显下降(均P=0.001).与阻黄组相比,阻黄+脾切除组的平均肠绒毛高度和隐窝深度有所上升(P=0.019、0.001).免疫组化显示术后7 d阻黄组ZO-1蛋白强阳性表达数(6/18)下降明显(P=0.021),阻黄+脾切除组(8/17)染色较阻黄组变化不大;闭锁蛋白的染色阻黄+脾切除组强阳性表达(7/17)高于阻黄组(4/18)(P=0.026).通过对Western印迹图像进行定量分析也得出同样的结论.结论 阻黄后肠黏膜通透性增加,肠黏膜屏障受损.同时切除脾脏,肠紧密连接蛋白成分的数量和分布改变,肠黏膜屏障的损害减轻.

Abstract：

Objective To investigate the effects of splenectomy on the intestine mucosa barrier in rats with obstructive jaundice. Methods 50 Wistar rats were divided randomly into the obstructive jaundice group (OJ), in which the animals underwent operation to ligate common bile duct, and the obstructive jaundice + splenectomy group (OJ+ S). Seven days post-operation, plasma endotoxin levels were detected. Intestinal mucosa permeability was measured by the ratios of lactulose and mannitol (L/M). Immunohistochemistry and Western blot were used to examine the expression of tight junction proteins (ZO-1 and occludin) in the distal ileum mucosa. Western blots images were analyzed quantitatively. Results Average ratios of L/M and plasma endotoxin were decreased obviously in the OJ+S group compared to those in the OJ group (all P=0. 001). Compared with the OJ group, the average intestinal villus height and mucosa thickness were upgraded somewhat in the OJ + S group (P = 0.019, 0. 001 ). By immunohistochemistry staining seven days post-operation, same comment as above the amounts of strong positive expression of ZO-1 were significantly decreased in the OJ group (6/18, P-0. 021). There wewas no difference between the OJ+S group(8/17) and the OJ group.The amount of strong positive expression of occludin was higher in the OJ + S group than that of the OJ group(10/17 vs 4/18, P= 0. 026). The same outcomes were obtained by quantitative Western blot images. Conclusion The intestinal epithelial permeability was increased in rats with obstructive jaundice,and intestinal barrier was damaged. After excising spleen, the amount and distribution of tight junction proteins were changed and the impairment of intestinal barrier was abated.     

呼气氢试验对恶性梗阻性黄疸患者围手术期小肠细菌移位的判断价值

目的:研究恶性梗阻性黄疸患者围手术期血浆内毒素（PE）的动态变化，应用呼气氢试验（HBT）判断小肠细菌的移位及其意义。方法:选择38例可行手术治疗的恶性梗阻性黄疸患者为试验组（A组），健康受试者30例为对照组（B组）。观察A组患者术前、术后PE的变化及HBT的结果，并与B组进行比较。结果:入院时A组PE水平为(0.69±0.22)EU/mL（Endotoxin Unit per mL），与B组（0.17±0.05）EU/ mL相比差异有显著性（P＜0.01）；A组术前1d PE下降不明显（P＞0.05），术后下降显著（P＜0.05）。A组入院时，术前1 d，术后3， 7，14 d HBT阳性率分别为86.8 %，73.7 %，39.5 %，21.1 %和7.9 %；B组阳性率为6.7 %。A组入院时与B组相比差异有显著性（P＜0.05）。A组术后3，7 d与术前1d相比较差异有显著性（P＜0.05）。结论:恶性梗阻性黄疸患者存在肠道细菌移位，合并不同程度的内毒素血症。呼气氢试验是判断恶性黄疸患者围手术期小肠细菌移位的较好指标。     

Endotoxemia in obstructive jaundice. Observations on cause and clinical significance

Perioperative endotoxemia was detected in 24 of 40 patients who underwent operation for obstructive jaundice (bilirubin level greater than 5.8 mg/dl). Endotoxemia was associated with an increased admission serum bilirubin level (p less than 0.05) and white blood cell count (p less than 0.05) and a decreased hematocrit value (p less than 0.05), but there was no significant association with other established preoperative risk factors. Patients with preoperative endotoxemia had a decreased immunoglobulin M anti-J5 endotoxin titer (p less than 0.05) and a decreased serum bile acid concentration (p less than 0.05). Preoperative endotoxemia was associated with reduced creatinine clearance before and after operation (p less than 0.05). There was no association between endotoxemia and clinical sepsis, gram-negative infection, or small-bowel colonization. Patients who died had increased preoperative serum fibrin degradation products (p less than 0.05).     

阻塞性黄疸术前行PTCD对提高临床疗效的观察

目的 探讨阻塞性黄疸术前经皮肝穿刺胆管引流（PTCD）对围手术期的影响及临床疗效。方法 2010年2月至2012年6月间手术治疗的85例阻塞性黄疸患者,分为术前PTCD术组（n=46）和直接手术组（n=39）;术前PTCD组观测入院时和行PTCD置管后第3、7天肝功能指标变化情况,同时比较两组术中出血量、手术时间,术后并发症及平均住院时间,术后肝功能指标变化。结果 PTCD组行PTCD置管后肝功能改善,与入院时比较有明显差异（P＜0.05）。两组术后ALT、AST、TB指标相同时间点比较,差异均有统计学意义（P＜0.05）。同时,PTCD组术中出血量、手术时间、术后并发症及平均住院时间均少于直接手术组（P＜0.05）。结论 PTCD可作为阻塞性黄疸术前的常规应用,可促进肝功能的恢复,提高手术的耐受性,改善疗效。     

An assessment of monocyte procoagulant activity in patients with solid tumors

Generation of thromboplastin by monocytes has been shown to play a vital role in hypercoagulable states seen in malignancy. The purpose of this study was to compare the procoagulant activity in cancer patients and controls. Recalcification times (RT) of whole blood from 19 normal volunteers, 8 patients with benign polyps, 12 patients previously treated by surgery for head and neck (H&N) or colon cancer, and 13 untreated patients with various stages of H&N or colon cancer were determined. Tests were performed with and without stimulation with Escherichia coli endotoxin. The mean RT in saline (RTS) of untreated patients with early cancer (4.58 +/- 0.83 min) and that of patients with advanced cancer (5.23 +/- 1.16 min) were lower than that of controls (6.55 +/- 0.82 min), P less than 0.01 and P less than 0.05, respectively. The RTS of patients previously treated and of those with benign polyps were no different from those of controls. Activation with endotoxin significantly lowered the recalcification times (RTE) in the early (3.90 +/- 0.58 min) and advanced cancer patients (4.23 +/- 0.66 min) compared to the RTE of controls (5.69 +/- 0.75 min, P less than 0.01 for both groups) as well as compared to those with benign tumors, P less than 0.05. The mean RTE of previously treated patients (4.72 +/- 0.58 min) was also lower than that of controls, P less than 0.05. Our results suggest that RT is significantly reduced in cancer patients compared to that of controls. Furthermore, monocyte activation with endotoxin may enable us to distinguish cancer patients from controls as well as from those with benign tumors.     

乳果糖对急性胆道梗阻并内毒素血症患者肾功能的保护作用

目的　探讨乳果糖对急性胆道梗阻患者肾功能的保护作用及其机制。方法　 5 5例急性胆道结石梗阻患者随机分为乳果糖组 (L组 ,n =2 8)和对照组 (C组 ,n =2 7) ,分别于术前 3d连续口服 5 0 %乳果糖 (L组 )或 10 %葡萄糖 (C组 ) ,定期测定外周静脉血及术中门静脉血内毒素 (ET )浓度 ,血尿素氮 (BUN )及内生肌酐清除率 (Ccr)。结果　 (1)L组在第 4天 (手术当天 ) ,第 9天 (手术后第 5天 )时外周血ET水平及BUN浓度均显著低于C组 (P <0 .0 1,P <0 .0 5 ) ;Ccr显著高于C组(P <0 .0 1)。与第 1天 (服药前 )相比 ,外周血ET水平在第 4天 ,第 9天均显著降低 (P <0 .0 5 ) ,Ccr在第 4天 ,第 9天均显著升高 (P <0 .0 1,P <0 .0 5 ) ,BUN在第 4天显著下降 (P <0 .0 1)。和第 4天相比 ,外周血ET在第 9天显著下降 (P <0 .0 5 )。 (2 )在C组 ,和第 1天相比 ,外周血ET在第4天显著升高 (P <0 .0 5 ) ,Ccr在第 4天及第 9天显著下降 (P <0 .0 5 ,P <0 .0 1) ,BUN则无明显改变 (P >0 .0 5 ) ;和第 4天相比 ,外周血ET及Ccr在第 9天均显著下降 (P <0 .0 1)。 (3 )L组门静脉血ET水平显著低于C组 (P <0 .0 1) ,第 4天两组门静脉血ET水平均显著高于外周血ET水平　 (P <0 .0 1)。 (4 )L组第 4天肾滤过及肾小管功能受损发生率明显低于     

阻塞性黄疸术前经皮肝穿刺胆管引流对围手术期的影响

【Abstract】〓Objective〓To summarize the experience in treatment of the obstructive jaundice by preoperative percutaneous puncture of liver bile duct drainage. Methods〓Eight-six patients with obstructive jaundice were included and divided into two groups according to the operation procedure, 44 cases were given preoperative percutaneous transhepatic cholangial drainage(observation group) and then,.underwent internal or external drainage or radical operation,.42 cases were served as control group without preoperative percutaneous transhepatic cholangial drainage..Intraoperative blood loss, operative time,..hospital stay and complications were compared between two groups. The preoperative and postoperative liver function tests,such as total bilirubin(TB),.serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) were evaluated and compared in two groups. Results〓The operation time,.blood loss,.length of hospital stay and complication rates between observation group were lower than that in control group (P<0.05). The levels of TB, ALT, AST in 14 days after operation reduced in two groups, but were significantly decreased in observation group,.as compared to control group (P<0.05). Conclusion〓For patients with obstructive jaundice, preoperative percutaneous transhepatic cholangial drainage would shorten the length of hospital stay,.reduce complications occurrence,.and improve liver function.