Several unusual manifestations such as white bile draining in common bile duct (14 cases) and casual massive bleeding (2 cases ) during and following hepatobiliary and pancreatic operations is reported. These manifestations were in fact signs of hepatic insufficiency. The manners of manifestations of hepatic insufficiency and their treatment are discussed, with a stress that liver-protective treatment and nutritional support are the fundamental modalities.
ObjectiveTo analyze the risk factors of acute pancreatitis (AP) associated with hepatic dysfunction. MethodsWe collected the clinical data of AP patients from June 2012 to December 2014. According to the hepatic function, patients were divided into normal or mildly abnormal group (A), moderately abnormal hepatic function group (group B) and hepatic failure group (group C). We comparatively analyzed the relationship of abnormal hepatic function with causes (biliary, alcoholic, hypertriglyceridemia, and the others), age, gender, abdominal CT findings, laboratory test results, Ranson scores and the severity of acute pancreatitis bedside index (BISAP). ResultsA total of 117 AP patients were included in the study, including 75 males and 42 females aged from 28 to 71 years with the mean age of (53.21±1.35) years. There were 73 patients with mild AP (MAP), 28 with moderately severe AP (MSAP) and 16 with severe AP (SAP). There were 64 patients in group A, 37 in group B, and 16 in group C, in whom 73 patients were with hepatic dysfunction. The ratio of SAP and MSAP in group C was 75.0%, and MAP was 25.0%. There were 52 patients with bilious AP, 39 with alcoholic AP, 19 with hypertriacylglycerolemia AP, and 7 with others; the difference in causes among the three groups were not significant (P > 0.05). The differences in serum amylase, prothrombin time, white blood cells count, serum creatinine, triglycerides, total cholesterol, hemoglobin, and blood urea nitrogen among the three groups were not significant (P > 0.05). ConclusionsAP associated with hepatic dysfunction or failure may be caused by a various of factors. Whether the changes of serum amylase, prothrombin time, white blood cell count, serum creatinine, triglycerides, total cholesterol, hemoglobin, blood urea nitrogen, and BISAP scores can be the indexes of the judgment of AP with hepatic dysfunction needs more researches. Proper assessment of the related risk factors helps to prevent serious hepatic dysfunction or even failure.
We have measured the serum levels of total cholic acid (TCA) in 103 samples of obstructive jaundiced patients (OB group) and 83 samples of gallbladder stone patients without jaundice (control group) by enzymeconjugated colorimetric analysis method. The results revealed that TCA level was higher in OB group than in control group (Plt;0. 001) and had postive correlation with total bilirubin, direct bilirubin and alanine aminotransferase in OB group (Plt;0.01 in all). The clinical value of TCA in obstructive jaundice in comparison with alkaline phosphatase is discussed.
Objective To explore favorable factors of reducing incidence of postoperative liver failure after radical resection of Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma in condition of hyperbilirubinemia. Methods All the clinical data of one patient with Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma underwent radical resection in June 2017 in the West China Hospital of Sichuan University were collected. The preoperative total bilirubin level of this patient was 470.3 μmol/L, the patient didn’t receive preoperative biliary drainage. The preoperative jaundice time and cholangitis were calculated accurately. A 3D imaging system for quantitative evaluation of the liver was used to reconstruct the images with contrast-enhanced CT images of this patient. And the total liver volume and the future liver remnant volume (FLRV) were calculated. Finally, 6 months of follow-up were conducted after surgery. Results The exact jaundice time was 20 d and there was no preoperative cholangitis. The postoperative FLRV accounted for about 70%. No postoperative liver failure occurred. No recurrence of tumor and death of patient occurred after 6 months of follow-up. Conclusions Radical resection of hilar cholangiocarcinoma in condition of hyperbilirubinemia is not an absolute contraindication for surgery, but indications should be strictly controlled. For special patient whose jaundice with short duration, no preoperative cholangitis and a high FLRV may be treated with directly radical surgery to prevent for losting the best time of surgery.
Objective To discuss the relationship between the efficiency of bile duct drainage and the postoperative liver functional recovery and the prognosis of hilar cholangiocarcinoma. Methods We studied retrospectively 58 cases of hilar cholangiocarcinoma which entered our department between June 1987 and October 1998. The postoperative liver functional recovery and mortality and morbidity between unilateral (n＝27) and bilateral (n＝31) bile duct drainage groups were compared. Results The liver function in bilateral drainage group was nearly normal within 6 weeks after operation. The ALb level of unilateral drainaged patients recovered gradually to normal after operation, and the TBIL and ALT decrease nearly to the normal range within 6 weeks after operation. The AKP decreased within 2 postoperative weeks, then steadily increased. The differences of perioperative complication rate and mortality of the two groups showed no significance. Conclusion The data showed that the liver function can recover to some extent by unilateral bile duct drainage, and unilateral drainage operations are the choice for hilar cholangiocarcinoma that can not be excised now.
目的:了解正常妊娠婦女血清中常用肝功能指標測定結果及變化。方法:分別在早孕（孕10～14周）、中孕（孕20～24周）、晚孕（孕30～34周）及產后（產后12周）四個時期序貫性測定120例正常妊娠婦女血清谷丙轉氨酶（ALT）、谷草轉氨酶（AST）、γ谷氨酰轉移酶（GGT）、乳酸脫氫酶（LDH）、總膽紅素（TBIL）、直接膽紅素（DBIL）、總蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）的水平并進行比較。結果:ALT、AST在早、中、晚孕及產后各期相對于正常對照均升高（P＜0.01）；TBIL和DBIL在早、中、晚孕均降低（P＜0.01）；TP、ALB隨孕期增加逐漸下降,產后回升,到產后12周上升到正常水平（早、中、晚孕P＜0.01,產后P＞0.05）；GGT在孕期中逐漸升高,于晚孕期達最高峰（P＜0.01）,產后稍有下降；LDH在孕早中期無明顯變化（P＞0.05）,孕晚期上升,到產后12周仍呈一上升趨勢（P＜0.01）；PA在孕早期低于正常對照（P＜0.01）,后隨孕期上升,到中孕期后上升到正常（P＞0.05）。結論:本次實驗觀察到在妊娠期肝功指標ALT、AST、GGT、LDH升高,可能因為孕婦肝臟負荷增加、基礎代謝和能量消耗增多、甾體激素水平增高引起。膽紅素代謝指標及營養性指標TBIL、DBIL、TP、ALB、PA降低,可能是妊娠期血漿稀釋引起。臨床診斷妊娠合并肝功能損害時應考慮上述變化。
Abstract: Objective To evaluate the protective effects of Ulinastatin on the peri-operative liver and renal function in patients undergoing cardiac surgery for tetralogy of Fallot (TO F). Methods Thirty-eight patients with TOF were divided into Ulinastatin group and control group according to admission sequence, 19 cases in each group.For Ulinastatin group, intravenous Ulinastatin was given with a dosage of 10 000U /kg at 1h before operation, 1h and 24 h after operation. For control group, no Ulinastatin was given. 10 ml fresh urine and 2 ml blood samples were collected before operation, and postoperative 1h, 10h, 24h, 48h and 72h, respect ively. The liver and renal functions were measured. Fluid intake, urine output, chest drainage, dosage of furosemide, durations of mechanical ventilation and intensive care unit ( ICU ) stay were recorded. Results Neither arrhythmia nor low cardiac output syndrome occurred for both groups. No peri-operative death. Compared with control group, dose of furosemide, period of mechanical ventilation were lower, while urine output was higher in Ulinastat in group; the aberrant climax value of urine pro tein and N-acetylglucosam inidase (NAG) were lower in Ulinastatin group (10h post-operat ively, urinem icroalbum in: 65. 2 ± 58. 3mg/L vs. 71. 8 ±58. 9mg/L ; urine transferrin: 5. 8 ± 3. 6mg/L vs. 7. 4 ± 5. 4mg/L ; urine immunoglobulin G: 26. 9±20. 3mg/L vs. 31. 3±23. 3mg/L ; 1h post-operat ively; urine NAG: 61. 4±81. 6U /L vs. 76.1±48. 5 U /L ; P lt; 0. 05) and maintained in shorter period (P lt; 0. 05) , it returned to baseline value at 48h and 72 h post-operatively. The value of alanine aminotransferase (ALT) significantly increased post-operatively at every time points in control group (P lt; 0. 01) , w hile no obvious change in Ulinastat in group (P gt; 0. 05). The increased value of aspartate aminotransferase (AST ) in Ulinastatin group was significantly lower than that in control group (10h post-operat ively: 144. 4±20. 8U /L vs. 202. 7±74. 1U /L ; P lt; 0. 01). The value of AST returned to baseline value at 48h and 72h post-operat ively. Conclusion U linastatin is an effect ive strategy for protecting peri-operat ive liver and renal function of the patients with tetralogy of Fallot and the clinical application of Ulinastatin is safe and effective.
目的探討腹腔鏡與開腹膽囊切除術對患者肝功能及免疫功能的影響。 方法根據手術方式將84例膽囊良性病變患者分為腹腔鏡膽囊切除術組（LC組，50例）及開腹膽囊切除術組（OC組，34例），比較2組患者手術前后肝功能及免疫功能指標的變化。 結果2組患者肝功能在手術前后不同時間點的差異均無統計學意義（P＞0.05）；LC組患者術后免疫功能各指標與術前比較無明顯變化（P＞0.05），OC組CD3+、CD4+及CD4+/CD8+在術后1 d及3 d均較術前明顯降低（P＜0.05），術后7 d恢復至術前水平（P＞0.05）。 結論LC術可引起患者術后肝功能短暫異常，但對免疫功能無明顯影響，可作為膽囊切除的首選術式。
Objective To estimate the relationship between arterial blood ketone body ratio (AKBR) and liver function and to appraise the feasibility of adding AKBR into liver function estimate. MethodsFrom 1994 to 1998, 44 patients with unresectable liver cancer recieved the combined radiochemoembolization with mixed emulsion of phosphorus32 glass microspheres (32PGMS), chemoagent and glycerine or lipiodol, via intraoperative hepatic artery instillation, hepatic artery ligation and operational arterial embolization (HAL+OAE) or transcatheter hepatic artery embolization (TAE). Preoperative and postoperative function and energy change level of the liver were tested by liver function test and AKBR. CT, SPECT, AFP were used to judge the therapy effect; multivariate statistical analysis methods were used to evaluate the correlation between AKBR and liver function. Spearmen rank correlation analysis was used to evaluate whether there was any relationship between AKBR and liver function test, and to evaluate that there was any relationship between AKBR and survival time. ResultsA negative correlation showed between the level of AKBR and liver function. The correlation coefficient of the three level of AKBR before operation and survival time was 0.4409. Conclusion AKBR can well reflect the degree of liver function.
【摘要】 目的 分析慢性乙肝患者血清生化、血常規、血清病毒載量及乙型肝炎標志物與肝組織炎癥分級、纖維化分期的相關性,以找到有較好相關性的臨床指標；通過肝活檢證實臨床診斷與病理診斷的符合情況,探討肝活檢的重要性及價值。方法 對2007年6月—2009年8月在傳染科行肝穿刺活檢的359例慢性乙型肝炎患者的血清丙氨酸氨基轉移酶(ALT)、門冬氨酸氨基轉移酶(AST)、總膽紅素(TB)、白蛋白(ALB)、球蛋白(GLB)等指標,白細胞(WBC)、血小板(PLT)等指標,凝血酶原時間(PT),血清HBV DNA定量及乙肝標志物的不同狀態與肝穿病理分級、分期的相關性進行分析；統計慢性乙肝患者臨床診斷與病理診斷的符合情況。結果 肝組織炎癥分級及纖維化分期之間有一定相關性(Plt;0.05)；血清ALT、AST、ALB、GLB、PT有助于判斷肝組織炎癥程度(Plt;0.05)；ALB、GLB、WBC、PLT、PT對肝組織纖維化程度的評估有意義(Plt;0.05)；HBV DNA復制水平與肝組織炎癥及纖維化無關(Pgt;0.05),但存在負相關的趨勢；纖維化程度高的患者HBeAg陰性組較HBeAg陽性組更多(Plt;0.05)。慢性乙型肝炎患者臨床與病理診斷總符合率為56.3％。結論 動態監測慢性乙肝患者肝功能、血常規、凝血常規在一定程度上有助于判斷疾病的程度,但要確診肝組織炎癥分級及纖維化分期,肝組織病理活檢是必需的。