胆道阻塞解除后肝功能指标的临床观察与评价

Clinical observation and evaluation of liver functional restoring changes after releasing from binary obstruction

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.