胃、十二指肠手术后非外科性黄疸的临床特点与治疗

Clinical features and treatment of non-injury jaundice after operation of stomach or duodenum

目的探讨胃、十二指肠手术后出现非外科性黄疸的诊治。方法回顾性分析31例实施胃、十二指肠手术后出现非外科性黄疸患者的临床资料。结果31例胃、十二指肠术后患者黄疸出现时间为（8．0±3．5）d，总胆红素均值为71．2μmol／L，血清r谷氨酰转移酶均值为79．8U／L，影像学MRCP、CT或ERCP均证实无肝内外胆管梗阻或损伤；给予解痉、生长抑素、糖皮质激素、护肝、利胆等对症治疗（9．0±4．3）d，若系感染所致的黄疸需抗感染1周左右，均治愈。结论胃、十二指肠手术后出现的非外科性黄疸，应结合临床、手术方式、实验室检查等，从患者肝功能状态、肝脏储备功能及治疗效果综合分析。药物性肝细胞性损害、胆汁淤滞、胆道感染、输血以及Oddi括约肌痉挛等可能是黄疸症状出现的主要因素，对症对因处理可起到良好的效果。

Objective To investigate the diagnosis and treatment of non-injury jaundice after operation of stomach or duodenum. Methods The clinicopathological data of 31 cases of non-injury jaundice after operation of stomach or duodenum were retrospectively analyzed. Results Jaundice in 31 cases after operation of stomach or duodenum occurred in （8. 0 ± 3.5） days, the mean value of TBIL was 71.2 μmol/L, and γ-GT was 79. 8 U/L. The results of MRCP, CT or ERCP revealed no obstruction or injury of the bile ducts. All these patients were cured after symptomatic treatment for （9. 0 ± 4. 3） days. Conclusion The non-injury jaundice after operation of stomach or duodenum should be compre- hensively analyzed according to the clinicopathological data： clinical manifestation, surgical approach, laboratory parameters, etc. Druginduced liver cell damage, bile stasis, biliary infection, blood transfusion and Oddi sphincter spasm are the main reasons. The specific and prompt treatments for different etiological factors can improve and control the complications effectively.