良、恶性阻塞性黄疸患者梗阻解除后肝功能变化的比较

The Evaluation of Liver Function Before and After Relief of Biliary Obstruction

目的比较良、恶性阻塞性黄疸患者胆道梗阻解除后的肝功能变化。方法对胆总管结石所致阻塞性黄疸患者(24例)行EST-ENBD治疗。胆管及壶腹部恶性肿瘤患者(20例)行PTCD胆管支架及内外引流术解除梗阻。检测比较患者术前1～3d及术后3d和7d的有关生化指标,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)、直接胆红素(DBIL)及胆汁酸(TBA)。结果(1)ENBD和PTCD两种方法整体上都可有效解除梗阻,通畅引流胆汁,减轻或消退黄疸(7d时两组TBIL分别下降约63%和33%)。与治疗前相比,随着梗阻的解降,各项肝功能指标亦逐步下降。(2)与梗阻解除前相比,两组患者治疗后ALT、AST及TBA均显著下降(P<0.05)。良性梗阻组ENBD治疗前后TBIL、DBIL有显著差异(P<0.01)。恶性梗阻组治疗后TBIL、DBIL数值较治疗前下降,但无统计学意义(P>0.05)。结论对于良性阻塞性黄疸,EST/ENBD可有效解降梗阻,减轻黄疸,促进肝功能的恢复。而恶性阻塞性黄疸,PTCD胆管支架及内外引流术可以解除梗阻,通畅引流,促进转氨酶下降,但黄疸消退效果欠佳,可能有胆汁淤积等其它因素参与黄疸形成。TBA为反映胆道梗阻状态的较好指标。

Objective To exploe the changes of liver function markers after relief of biliary obstruction in patients with benign or malignant jaundice. Methods 24 patients with cholangiolithiasis underwent endoscopic sphincterotomy（EST） and endoscopic nosahiliary drainage （ENBD）. 20 patients with malignant obstructive jaundice underwent percutaneous transhepatic cholangiographic drainage（PTCD） and posting of biliary metallic stents. Alanine transaminase（ALT） ,aspartate aminotransferase （ AST）, alkaline phosphatase （ ALT ）, glutamyltransferaseand （ GGT ）, total bilirubin （ TBIL ）, idirect bilirubin （ DBIL ） and total t . bile acid （TBA） were measured just before and 3rd ,7th days after releasing from biliary obstruction. -Results , （ 1 ）The jaundice of benign or malignant wer decreased when obstruction were released. To following, all of the liver function markers after relief of biliary obstruction decreased ,the levels of TBIL of benign and malignant jaundice decreased by 63% and 33% on 7th days after relief of obstruction, respectively. （2）Compared to before relief of biliary ohstuction, ENBD decreased significantly the levels of almost of liver function markers（ ASTIAST,TBA,TBIL and DBIL） on 3rd and 7th days after relief of biliary obstruction（ P 〈 0. 05 ）. The level of ALT, AST and TBA were significantly decreased in PTCD groups, too（ P 〈 0. 05 ）. However, the decrease of TBIL and DBIL weren＇ t significant in PTCD groups （ P 〉 0. 05）. Conclusion With regard to benign obstructive jaundice,EST combined with ENBD can relieve obstruction and promote the recovery of liver function. PTCD combined with biliary tract stents is a effective method to relieve malignant hiliary obstruction and promote decrease of the transaminase. Because of the changes of jaundice weren＇ t significant, there were others causes to participate in the jaundice, for instance cholestasis. TBA is a better sensitive market for biliary obstruction.