摘要
对11例黄疸持续时间>1个月的梗阻性黄疸患者做了术前及术后1、3、7d肝吲哚氰绿(ICG)排泄试验.并做了血清胆红素、甘氨结合胆酸、AKP、GPT、总蛋白、A/G等肝功能指标测定.结果:术前血清胆红素均值达正常30倍(304±92mg·L-1).甘氨结合胆酸达40倍.AKP为4倍.吲哚氰绿血浆15min滞留率(ICGR15)为5.6倍.吲哚氰绿清除率(ICGkm)为正常1/4。术后血清胆红素等下降迅速.术后1Wk胆红素较术前已平均下降了50%;胆酸下降75%.AKP下降55%;而ICG滞留率和清除率恢复缓慢(ICGR15下降16%,ICGkm上升0.018).这种恢复速度的不同导致ICG测定值和其它检测指标的曲线分离。GPT、总蛋白、A/G在手术前后无明显变化,表明GPT、总蛋白、A/G在反映胆道阻塞时肝细胞功能损伤及再通手术后肝功能恢复方面敏感性低,而胆红素、胆酸等值的迅速下降则更多的反映胆道通畅情况.而不是肝功能的恢复程度。动物实验研究显示胆道阻塞引起的肝细胞损害在胆道再通后恢复缓慢.因此ICGR15和ICGkm的改变似能更好地反映肝细胞功能的恢复状况。
Our clinical studies were made on 11 patients of binary obstruction of more than 1 month duration, ICG liver excretion test,serum bilirubin, glycine conjugated bile acid (GCBA),AKP, GPT, tolal serum protein(TSP)and A/G ratio were measured just before and l,3 and 7 days after binary drainase operations. Before operations, the mean serum bilirubin level was(304±93mg. L-1)30 times higher than normal. GCBA 40 times, AKP 4 times, ICGR15 5. 6 times than normal respectively, ICGkm was 1/4 as compared with normal level. One week after operations, serum bilirubin decreased to 50%, GCBA 75% and AKP 55% as compered with preoperation level. But ICGR15 clecreased only 16% and ICGkm. increased 0. 018.Therefore,the recovery of ICG excretion behaved differently from that of other liver functional tests postoperatively. GPT.TSP and A/G ratio showed little changes after the operations. Rapidly lowering of serum bilirubin, GCBA and AKP levels after operations suggested successful binary decompression, while ICGR15and ICGkm. may be more likely to be valuable in reflecting hepatic functional improvement since slow heretic structural recovery was noted after prolonged binary obstruction in our animal experiments.
出处
《肝胆外科杂志》
1994年第2期101-106,共6页
Journal of Hepatobiliary Surgery
关键词
胆道阻塞
外科手术
肝功能
obstructive jaundice
indocyanine green
bilirubin
glycine conjusated bile acid
alkaline phosphatase