Therapeutic Effect of Plasma Exchange with the Biliary Drainage in the Treatment of Obstructive Jaundice

The effect of therapeutic plasmapheresis combined with biliary drainage was evaluated in obstructive jaundice animal models. Plasma exchange (PE) using fresh-frozen plasma was carried out with biliary drainage (BD) on a canine jaundice model created by the ligation and resection of bile duct. Routine biochemical analyses were done following PE and BD. The result was compared with that of a BD only group. Plasma bilirubin level abruptly dropped after PE and was kept at a lower level, whereas the bilirubin level of the drainage alone group decreased gradually. Decreased plasma mitochondrial GOT level in the PE group suggests improvement of liver cell damage in obstructive jaundice. Mitochondrial function of liver tissue was evaluated following partial hepatectomy, which was carried out 2 days after PE along with BD in jaundice rat. Mitochondrial respiratory control ratio and ADP/O ratio following hepatectomy were improved in the PE group. The results suggest the improvement of hepatic functional reservoir by a single PE treatment in addition to BD treatment. These results show that PE can shorten the icteric period and may improve the hepatic functions after the treatment of malignant obstructive lesion in the biliary tract.     

Differences in biliary lipid excretion after major hepatectomy in obstructive jaundiced rats with preoperative internal,external, or no biliary drainage

Necessity of preoperative biliary drainage for patients with obstructive jaundice is still controversial. We recently reported that liver regeneration after major hepatectomy was better restored in a rat model of obstructive jaundice with preoperative internal biliary drainage than that without biliary drainage or with external biliary drainage. The aim of this study was to investigate the differences in biliary lipid excretion after hepatectomy in obstructive jaundiced rats with or without preoperative internal or external biliary drainage. After bile duct ligation for 7 days, rats were randomly divided into the three groups; obstructive jaundice-hepatectomy (OJ-Hx), internal biliary drainage-hepatectomy (ID-Hx), and external biliary drainage-hepatectomy (ED-Hx) groups. 70% hepatectomy and internal biliary drainage were carried out 7 days after biliary decompression in the latter two groups and without biliary decompression in the OJ-Hx group. On the day of and on days 1, 2, 3 and 7 after hepatectomy, the liver weight, DNA synthesis rate, biliary lipids excretion rates, and bile acid composition were determined. In the ID-Hx group, the DNA synthesis rate and relative liver weight were significantly higher than those of the OJ-Hx and ED-Hx groups. The excretion rates of biliary lipids were disturbed in the ED-Hx group compared with those in the ID-Hx group and the values in the OJ-Hx group were in-between the ID-Hx and ED-Hx group. The liver regeneration rate was significantly correlated with bile flow and excretion rates of biliary lipids. The maintenance of enterohepatic circulation of biliary lipids before hepatectomy may be important for the liver regeneration.     

Pathophysiology of obstructive jaundice and its surgical problems

Mitochondrial respiratory function, ketogenesis, collagen metabolism of the liver in rats, dogs and patients with obstructive jaundice were investigated. In animal experiments, it was revealed that mitochondrial respiratory function and ketogenesis decreased significantly with prolongation of biliary obstruction. Hepatic collagen content and its synthesis significantly increased in biliary obstruction. After relief of biliary obstruction in these dogs and patients, these functions and contents improved or returned to near normal levels according to the duration of biliary obstruction and period after relief. By steroid hormone and CoQ administration to jaundiced rats, improvement of mitochondrial function was obtained to some extent. Cross circulation between the jaundiced rat and normal one was performed and it was found that mitochondrial function in normal rat was decreased and that of jaundiced rat improved, especially in renal mitochondria. When major surgery is required in patients of biliary obstruction with severe jaundice, biliary drainage should be carried out first 4 to 6 weeks before major operation. Steroid or CoQ therapy and plasma exchange are also useful for these patients.     

<Emphasis Type="Bold">Obstructive Jaundice in Rats: Cause of Spatial Memory Deficits with Recovery after Biliary Decompression</Emphasis>

Children with end-stage liver disease have been found to have cognitive deficits. The aim of this study was to examine whether cholestatic jaundice causes spatial deficits in rats and if these cognitive deficits are reversed by biliary drainage. Rats were randomly divided into three groups. In the first group, the bile duct was ligated for 3 weeks (BDL group); in the second group, the proximal bile duct was ligated with a Broviac CV catheter for 2 weeks followed by a tube bilioduodenostomy (TBD group); in the third group, a sham operation was performed (SHAM group). All the surviving rats were assessed for spatial learning and memory (a major cognitive function in rats) by the Morris water maze task about 3 weeks after the first operation. Blood was aspirated by cardiocentesis and assayed for total bilirubin, albumin, ammonia, and hemoglobin levels on the day following the water maze task. During the four consecutive acquisition trial days of the Morris water maze, jaundiced rats (BDL group) had a significant longer latency to escape than the SHAM group (p < 0.05). Rats that underwent biliary decompression for 1 week (TBD group) showed improved status of the spatial deficit, as they required less time to reach the escape platform, approaching the performance of the SHAM group. The BDL group had a significantly higher serum ammonia level, higher bilirubin level, and lower hemoglobin level than the other two groups. After biliary decompression for 1 week, the serum albumin concentration in the TBD group still did not return to the level of the SHAM group. The results of this study suggest that long-term cholestasis results in spatial memory deficits in rats that correlate with anemia and hyperbilirubinemia encephalopathy. Early biliary decompression of obstructive jaundice improves spatial memory deficits, possibly related to the recovery of the serum ammonia and hemoglobin levels.     

Experimental study on lipid and bilirubin metabolism after biliary drainage for obstructive jaundice

BACKGROUND: The present experimental study was carried out to determine variations in bilirubin and lipid metabolism in obstructive jaundice after external biliary drainage alone and in combination with intraintestinal administration of the drained bile. MATERIALS AND METHODS: Variations in lipid and bilirubin metabolism were studied in adult mongrel dogs with obstructive jaundice treated by external biliary drainage (EBD) and EBD plus intraintestinal administration of autologous bile (IBD). RESULTS: There was no difference between these two groups in regard to the volume of excreted bile after drainage. The biliary concentration and total daily excretion of bilirubin were higher in the IBD group (P < 0.0001), but there was no intergroup difference in the rate of decrease of serum bilirubin. In regard to lipid metabolism, the levels of total cholesterol, triglyceride, and low-density lipoprotein were decreased after biliary drainage; improvement in lipid metabolism was more rapid in the EBD group. Although the triglyceride level was lower after drainage, the activity of HMG-CoA reductase, the level of high-density lipoprotein 3-C, and the carrier protein apolipoprotein A-I were increased after drainage, with more rapid improvement in the EBD group. CONCLUSIONS: To improve lipid metabolism in obstructive jaundice, external biliary drainage is superior in the early stages of treatment, while replacement by EBD plus intraintestinal administration of autologous bile may be advantageous in cases of prolonged use.     

Safe and Permissible Limits of Hepatectomy in Obstructive Jaundice Patients

The safe and permissible limits of hepatectomy in obstructive jaundice patients and the usefulness of preoperative portal embolization (PE) for increasing the limit for safe hepatectomy were examined. We classified 416 patients with hepatectomy performed over 9 years under the following headings: normal liver function (n = 242); chronic hepatitis (n = 71); liver cirrhosis (n = 64); and liver after relief of obstructive jaundice (n = 39). Hepatectomy was done after the total bilirubin level was reduced below 3 mg/dl by preoperative biliary drainage. Factors influencing the maximum total bilirubin level measured within 2 weeks after hepatectomy were investigated, and this level was taken to reflect the degree of surgical stress. PE was carried out in 18 patients with obstructive jaundice. The maximum total bilirubin, expressed as a logarithm, was significantly correlated with the percent of liver resected in all groups. Hepatectomy followed by a maximum total bilirubin of less than 8.5 mg/dl was accepted as safe, and hepatectomy followed by a bilirubin level of 14.4 mg/dl was deemed the maximum permissible resection. On the basis of these results, the safe and permissible limits of hepatectomy in patients with obstructive jaundice were 48.7% and 71.6%, respectively. PE decreased the maximum total bilirubin from 8.5 mg/dl to 3.9 mg/dl when 48.7% of the liver (a safe proportion in all cases) was resected; PE increased the safe limit of hepatectomy from 48.7% to 67.4% when a maximum posthepatectomy total bilirubin level of 8.5 mg/dl was accepted as safe.     

Significance of cross-circulation on obstructive jaundice in rats with special reference to the mitochondrial function of the liver and kidney

Cross-circulation was performed to investigate the mitochondrial respiratory function of the liver and kidney in rats after 1, 2 and 3 weeks of biliary obstruction. Serum bilirubin and total bile acids concentration in blood in rats with biliary obstruction markedly decreased with 3 hours cross-circulation. There demonstrated, however, no significant change in mitochondrial function in the liver after cross-circulation. In contrast, mitochondrial function in the kidney showed significant improvement after 3 hours cross-circulation. Mitochondrial respiratory function in normal partner rats cross-circulation with jaundiced rats demonstrated temporal deterioration in the kidney and prolonged deterioration in the liver. It can be concluded that cross-circulation or plasma exchange might be useful for the prevention of renal failure in obstructive jaundice, since cross-circulation induced persistent improvement of the mitochondrial respiratory function in the kidney deteriorated by biliary obstruction.     

不同胆汁引流方式对梗阻性黄疸兔血清内毒素与免疫功能的影响

目的:探讨不同胆汁引流方式对梗阻性黄疸兔血清内毒素与免疫功能的影响。方法:将36只新西兰白兔随机均分为假手术组、外引流组、内引流组。外引流组与内引流组先建立可逆型梗阻性黄疸模型,7 d后解除梗阻,分别行胆汁外引流与内引流;假手术组按相同时间间隔行2次假手术。各组分别于造模前、造模后7 d、引流术后7 d采血,检测肝功能指标、血清内毒素水平、血中CD4+CD25+调节性T细胞的比例。结果:假手术组各时间点各项指标均无明显变化(均P0.05);造模后7 d,外引流组与内引流组血清胆红素、转氨酶、内毒素水平均较造模前明显升高,血CD4+CD25+调节性T细胞比例较造模前明显降低(均P0.05);行引流术7 d后,外引流组与内引流组肝功能指标、内毒素水平、CD4+CD25+调节性T细胞比例均较造模后7 d明显恢复,但内引流组后两项指标的恢复程度均明显优于外引流组(均P0.05)。结论:胆汁内引流较胆汁外引流更有利于梗阻性黄疸内毒素清除与机体免疫功能快速恢复。     

The significance of serum mitochondrial aspartate aminotransferase activity in obstructive jaundice: experimental and clinical studies

The serum level of mitochondrial aspartate aminotransferase was determined in experimental and clinical obstructive jaundice, using an immunoabsorbance method which allowed the differential determination of cytosolic and mitochondrial isozymes in the serum. In experimental obstructive jaundice using dogs, the serum mitochondrial aspartate aminotransferase value rapidly decreased to normal after biliary decompression following a period of biliary obstruction of within 3 weeks. On the other hand, when the period of jaundice was prolonged for 5 weeks, the activity of the enzyme after biliary drainage still continued to show high values, being 14.2 +/- 1.8 Karmen units at 4 weeks following biliary decompression. Determination of aspartate aminotransferase activity in tissue from such organs as the liver, heart, kidney, skeletal muscle and brain, as well as serum samples withdrawn from local veins, confirmed that high serum values of the enzyme in experimental obstructive jaundice were mostly attributable to hepatic impairment induced by biliary obstruction not by secondarily damaged tissues of other organs. Mitochondrial aspartate aminotransferase proved to be a more useful marker than other routine tests in icteric dogs. In 13 clinical patients with obstructive jaundice, decreasing rates of serum mitochondrial aspartate aminotransferase on the 7th and 14th postoperative days could be applied to evaluate the viability of the icteric liver. The decreasing rates were more advantageous than the preoperative activity itself in predicting the postoperative function of the liver. Thus, mitochondrial aspartate aminotransferase appears to serve as a useful marker for assessing the liver function in obstructive jaundice.     

The significance of serum mitochondrial aspartate aminotransferase activity in obstructive jaundice: Experimental and clinical studies

The serum level of mitochondrial aspartate aminotransferase was determined in experimental and clinical obstructive jaundice, using an immunoabsorbance method which allowed the differential determination of cytosolic and mitochondrial isozymes in the serum. In experimental obstructive jaundice using dogs, the serum mitochondrial aspartate aminotransferase value rapidly decreased to normal after biliary decompression following a period of biliary obstruction of within 3 weeks. On the other hand, when the period of jaundice was prolonged for 5 weeks, the activity of the enzyme after biliary drainage still continued to show high values, being 14.2±1.8 Karmen units at 4 weeks following biliary decompression. Determination of aspartate aminotransferase activity in tissue from such organs as the liver, heart, kidney, skeletal muscle and brain, as well as serum samples with drawn from local veins, confirmed that high serum values of the enzyme in experimental obstructive jaundice were mostly attributable to hepatic impairment induced by biliary obstruction not by secondarily damaged tissues of other organs. Mitochondrial aspartate aminotransferase proved to be a more useful marker than other routine tests in icteric dogs. In 13 clinical patients with obstructive jaundice, decreasing rates of serum mitochondrial aspartate aminotransferase on the 7th and 14th postoperative days could be applied to evaluate the viability of the icteric liver. The decreasing rates were more advantageous than the preoperative activity itself in predicting the postoperative function of the liver. Thus, mitochondrial aspartate aminotransferase appears to serve as a useful marker for assessing the liver function in obstructive jaundice.     

Improved Cardiac Function in Patients With Obstructive Jaundice After Internal Biliary Drainage: Hemodynamic and Hormonal Assessment

OBJECTIVE: To investigate myocardial function in patients with obstructive jaundice before and after internal biliary drainage. SUMMARY BACKGROUND DATA: Increased plasma levels of atrial natriuretic peptide (ANP) have been found in patients with biliary obstruction. METHODS: Thirteen patients with newly diagnosed obstructive jaundice and no previous heart, lung, or renal disease were studied using a Swan-Ganz catheter. Hemodynamic measurements were taken before and 4 days after internal biliary drainage. Levels of ANP and brain natriuretic peptide (BNP) were obtained and liver function tests were also determined. RESULTS: Plasma levels of ANP and BNP were increased twofold to fourfold in the basal state and declined after biliary drainage. Independent variables predicting left ventricular systolic work were total bilirubin concentrations, duration of jaundice, and BNP. In addition, bilirubin concentrations correlated with pulmonary vascular resistance, mean arterial pulmonary pressure, and right ventricular systolic work. Internal biliary drainage resulted in an improvement in left ventricular systolic work. A correlation was found between decreasing ANP concentrations and increasing cardiac output. CONCLUSIONS: Increased plasma levels of natriuretic peptides in patients with obstructive jaundice may reflect a subclinical myocardial dysfunction correlating with the degree of jaundice. After internal biliary drainage, there is a measurable improvement of cardiac function.     

Metabolic alterations in obstructive jaundice: effect of duration of jaundice and bile-duct decompression.

We examined the effect of prolonged bile duct obstruction, and subsequent biliary decompression, on biochemical and metabolic parameters, using a reversible jaundice model in male Fischer 344 rats. The animals were studied after biliary obstruction for varying periods (4 days, one week, and two weeks) and following decompression. They were sacrificed one or two weeks following decompression. All the rats were compared to sham operated, pair-fed, controls. Obstructive jaundice rapidly increased bilirubin, liver enzymes, serum free fatty acid, and triglyceride levels. Glucose levels were significantly decreased in the jaundice rats compared to their pair-fed controls. Only after two weeks of jaundice was significant hypoalbuminemia observed. Following decompression, all biochemical and metabolic values gradually returned to normal levels, except for albumin. Hypoalbuminemia was not reversed within the two-week post-decompression period. The rats jaundiced for two weeks had significantly higher mortality, compared to the other groups. We conclude that prolonged jaundice adversely affects the metabolic capacity of the rats, with albumin concentration being markedly decreased, and that biliary decompression could not reverse completely all the alterations seen with cholestasis, especially following two weeks of bile duct obstruction.     

Value of preoperative drainage of the bile ducts in obstructive jaundice]

Hepato-biliary surgery for obstructive jaundice is associated with high morbidity and mortality rates. Experimental and clinical studies on obstructive jaundice revealed endotoxaemia, coagulation disorders and depressed immune function. Many studies have been carried out to identify the operative risk factors. The serum bilirubin level seemed to be a significant factor. Biliary decompression via a percutaneous or endoscopic retrograde approach was therefore proposed to improve the surgical outcome. The first retrospective studies have suggested a reduction of morbidity and mortality. Subsequent randomized studies have not confirm the benefit of preoperative biliary drainage because of procedure-related complications. The article reviews the literature on preoperative biliary drainage and proposes the indications, choice of method and optimal duration of biliary drainage.     

Effect of biliary decompression on reticuloendothelial function in jaundiced rats.

The recovery of reticuloendothelial system (RES) function following decompression of obstructive jaundice was studied using a rat model with bile duct ligation and side-to-side choledochoduodenostomy. Histopathological changes in the liver were still present 5 weeks after relief of jaundice, while results of liver function tests had returned to normal. RES function evaluated by the blood clearance and organ uptake of radiolabelled Escherichia coli using a corrected phagocytic index gradually returned to normal following biliary decompression. The severely impaired RES activity noted 1 week after operation may explain the increased incidence of sepsis and renal insufficiency in the early period after biliary surgery in jaundiced patients.     

Effects of biliary drainage in obstructive jaundice on microcirculation,phagocytic activity,and ultrastructure of the liver in rats

Background/Purpose: Biliary drainage before surgery for obstructive jaundice has been thought to be indispensable, because these patients tend to develop various complications after the surgery. We developed jaundiced rat models, and studied the effects of biliary drainage on the hepatic blood flow rate, portal pressure, and phagocytic activity. Methods: We generated rats with obstructive jaundice by surgical ligation followed by cutting of the common bile duct; some jaundiced rats then underwent biliary drainage. Lipopolysaccharide (LPS) was intraperitoneally administered to some rats. Control rats underwent open abdominal surgery alone. Ultrastructural changes of the liver sinusoidal endothelial cells were examined by scanning electron microscopy. Results: The hepatic blood flow rate and phagocytic activity in the jaundiced rats and the LPS-treated jaundiced rats were lower than those in the control rats. Biliary drainage improved the hepatic blood flow rate in both the jaundiced rats and the LPS-treated jaundiced rats to the control levels. Scanning electron microscopic observation of the liver sinusoids showed that, in the jaundiced rats, the endothelial cells were hypertrophic and there was a reduced number of fenestrae. In jaundiced rats that underwent biliary drainage, the hypertrophy was reduced, and the number of fenestrae was increased in comparison with those in the jaundiced rats without the drainage. Conclusions: These findings indicate that biliary drainage was effective in jaundiced and LPS-treated jaundiced rats. Received: November 16, 2001 / Accepted: February 11, 2002     

The Effect of Biliary Decompression on Bacterial Translocation in Jaundiced Rats

Patients with obstructive jaundice are prone to septic complications after biliary tract operations. Restoring bile flow to the intestine may help to decrease the complication rate. The present study is aimed at evaluating the effect of biliary decompression on bacterial translocation in jaundiced rats.Sixty-six male Sprague-Dawley rats were randomly allocated to six groups subjected to common bile duct ligation (CBDL) and transection (groups 2–6) or sham operation (group 1). In groups and 2 the incidence of enteric bacterial translocation was determined 2 weeks after sham operation or CBDL. In groups 3–6, biliary decompression was achieved by performing a choledochoduodenostomy after 2 weeks of biliary decompression. Bacterial translocation was then studied 1,2,3 and 5 weeks following biliary decompression.The rate of bacterial translocation to mesenteric lymph nodes in obstructive jaundice was significantly higher as compared with controls, and decreased with time to nil three weeks following biliary decompression. The incidence of bacterial translocation was closely correlated (r = 0.844; p = 0.034) with serum alkaline phosphatase activity and seemed to fit with the morphological changes noted in the small intestine. The decrease in bacterial translocation, however, lags behind the recovery of liver function as measured by routine liver function tests and antipyrine clearance.Obstructive jaundice thus promotes bacterial translocation in the rat. Biliary decompression gradually decreases the rate of bacterial translocation.     

The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy

BACKGROUND:

The benefit of preoperative biliary drainage in jaundiced patients undergoing pancreaticoduodenectomy for a suspected malignancy of the periampullary region is still under debate. This study evaluated preoperative biliary drainage in relation to postoperative outcomes.

STUDY DESIGN:

At the Academic Medical Center, Amsterdam, the Netherlands, a cohort of 311 patients undergoing pancreaticoduodenectomy from June 1992 up to and including December 1999 was studied. Of this cohort 21 patients with external or surgical biliary drainage were excluded and 232 patients who had received preoperative internal biliary drainage were divided into three groups corresponding with severity of jaundice according to preoperative plasma bilirubin levels: < 40 μM (n = 177), 40 to 100 μM (n = 32), and > 100 μM (n = 23) were designated as groups 1, 2, and 3, respectively. These groups were compared with patients who underwent immediate surgery (n = 58) without preoperative drainage.

RESULTS:

The median number of stent (re)placements was 2 (range 1 to 6) with a median drainage duration of 41 days (range 2 to 182 days) and a stent dysfunction rate of 33%. Although patients in group 1 were better drained than patients in groups 2 and 3 (median reduction of bilirubin levels 82%, 57%, and 37%, respectively, p < 0.01), there was no difference in overall morbidity among the drained groups (50%, 50%, and 52%, respectively). There was no significant difference in overall morbidity between patients with and without preoperative biliary drainage (50% and 55%, respectively).

CONCLUSIONS:

Preoperative biliary drainage did not influence the incidence of postoperative complications, and although it can be performed safely in jaundiced patients it should not be used routinely.     

Preoperative internal biliary drainage is superior to external biliary drainage in liver regeneration and function after hepatectomy in obstructive jaundiced rats

OBJECTIVE: To examine the differences in regeneration rates and functions of the liver at the time of and after hepatectomy in obstructive jaundiced rats with preoperative external and internal biliary drainage. SUMMARY BACKGROUND DATA: The significance of biliary drainage before surgery is controversial in patients with obstructive jaundice. METHODS: After biliary obstruction for 7 days, rats were randomly divided into three groups: obstructive jaundice and hepatectomy (OJ-Hx), external biliary drainage and hepatectomy (ED-Hx), and internal biliary drainage and hepatectomy (ID-Hx). The OJ-Hx group underwent hepatectomy without biliary drainage; the other two groups underwent hepatectomy after biliary drainage for 7 days. At the time of hepatectomy, all rats were provided with internal biliary drainage. On days 0, 1, 2, 3, and 7 after hepatectomy, the DNA synthesis rate and the concentrations of adenine nucleotides and malondialdehyde in the liver were determined as markers of the hepatic regeneration rate, energy status, and lipoperoxide concentration, respectively. Portal endotoxin concentrations were measured and serum hyaluronic acid concentrations were determined as an indicator of hepatic endothelial function. RESULTS: The relative liver weight was significantly higher in the ID-Hx group than in the OJ-Hx group on days 1, 3, and 7 after hepatectomy and than in the ED-Hx group on days 1 and 2. The rate of hepatic DNA synthesis was significantly higher in the ID-Hx group than in the OJ-Hx and ED-Hx groups on day 1. The rate was similar in the ED-Hx and ID-Hx groups on day 2 but was significantly higher than in the OJ-Hx group. The hepatic malondialdehyde concentration was significantly higher on day 1 in the ED-Hx group than in the other two groups. It was lowest in the ID-Hx group throughout the study. Both biliary drainage procedures lowered the portal endotoxin concentration and serum hyaluronic acid concentration at the time of hepatectomy. The serum hyaluronic acid concentration was lowest in the ID Hx group. Hepatic adenine triphosphate concentrations and energy charge levels were similar among the three groups. CONCLUSION: Although both external and internal biliary drainage before hepatectomy improved serum liver function tests, portal endotoxin concentration, and serum hyaluronic acid concentration at the time of surgery, preoperative internal biliary drainage was superior to external drainage, as evidenced by the better liver regeneration and function after hepatectomy.     

Experimental and clinical studies on the effects of supplemental administration of bile salts after relief of biliary obstruction

Changes of hepatic bile production and hepatocellular function such as bile acid and bilirubin excretion, BSP transfer rate constant, hepatic clearance of bile acid and ultrastructure of bile secretory apparatus after relief of biliary obstruction were investigated in both experimental rat model and clinical cases. The results were as follows: Increase in bile acid excretion after total bile fistula was significantly delayed in the jaundiced rats as compared with that of the control rats. In the jaundiced rats, bile salt-induced choleretic effect was significantly augmented and sodium taurocholate infusion caused a marked decrease in bilirubin excretion. Biliary transport of BSP was significantly decreased after biliary decompression, but showed remarkable restoration by simultaneous injection of sodium taurocholate. Hepatic clearance of 14C-taurocholic acid was disturbed in a group with long-term obstruction. The most remarkable morphological alterations were found in the bile canaliculus in the rat with relieved obstruction. Studies on clinical cases showed correlation between bile acid clearance and bilirubin excretion. In conclusion, effective elimination of plasma bilirubin after biliary decompression might be achieved by supplemental administration of bile salts, provided that bile acid clearance remains intact.     

阻塞性黄疸大鼠术前胆道内、外引流对肝细胞再生能力的影响

目的　探讨阻塞性黄疸大鼠肝叶切除术前胆道内、外引流对肝细胞再生能力的影响和机制。方法　将大鼠胆总管结扎 5d后 ,分别行胆道内、外引流 5d ,再行 70 %肝叶切除术。结果　胆道外引流组与内引流组和对照组大鼠相比 ,反映肝细胞再生能力的肝细胞核DNA含量、增殖细胞核抗原 (proliferatingcellnuclearantigen ,PCNA)指数、有丝核分裂指数 (mitoticindexMI)明显减低 (P <0 0 5 )。胆道外引流组肝细胞C met/HGF R基因表达也减低 (P <0 0 1)。结论　阻塞性黄疸大鼠肝叶切除术前胆道外引流对肝细胞再生能力有明显抑制作用 ;胆道外引流组肝细胞C met/HGF R基因表达减弱可能是该组肝细胞再生能力下降的重要因素。