胆道术后经鼻空肠管胆汁回输对肝功能的影响

Effect of bile reinfusion via nasojejunal tube on liver function after biliary tract surgery

目的 探讨胆道手术胆汁外引流患者经鼻空肠管胆汁回输对肝功能的影响.方法 将80例胆道手术胆汁外引流患者按随机数字表法分为胆汁回输组和对照组,每组40例.观察两组患者围手术期肝功能以及胆汁引流量等情况.结果 患者对胆汁回输的耐受良好,部分患者发生腹胀、恶心和呕吐,经对症处理后症状明显改善.胆汁回输组术后第5天丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）[（31±18）U/L比（48±32）U/L、（51±32）μmol/L比（76±38）μmol/L]和术后第7天天冬氨酸氨基转移酶（AST）、ALT明显低于对照组[（32±19）U/L比（43±26）U/L、（20±19）U/L比（31±22）U/L],差异有统计学意义（P〈0.05）.胆汁回输组术后第3和4天胆汁引流量明显高于对照组[（485±52）ml比（428±96）ml和（509±62）ml比（458±59）ml],差异有统计学意义（P〈0.01）.结论 胆道术后胆汁外引流患者的胆汁通过鼻空肠营养管回输,可以改善患者的肝脏功能.

Objective To discuss the clinical value of bile reinfusion via nasojejunal tube on liver function after biliary tract surgery. Methods Eighty patients with biliary tract surgery and bile outer drainage were divided into bile reinfusion group and control group by random digits table method with 40 cases each. The clinical data concerning the liver function and volume of biliary drainage were collected. Results The patients were well tolerated for bile reinfusion, and abdominal distension, nausea and vomiting occurred in some patients. The symptoms improved significantly after symptomatic treatment. The alanine aminotransferase （ALT） and total bilirubin （TBIL） levels at the fifth day after operation in bile reinfusion group were significantly reduced than those in control group：（31 ± 18） U/L vs. （48 ± 32） U/L and （51 ± 32）μmol/L vs. （76 ± 38）μmol/L, the aspartate aminotransferase （AST） and ALT levels at the seventh day after operation in bile reinfusion group were significantly reduced than those in control group： （32 ± 19） U/L vs. （43 ± 26） U/L and （20 ± 19） U/L vs. （31 ± 22） U/L, and there were statistical differences （P〈0.05）. The volume of biliary drainage in the bile reinfusion group was significantly increased compared with that in control group at the third and fourth day after operation：（485 ± 52） ml vs. （428 ± 96） ml and （509 ± 62） ml vs. （458 ± 59） ml, and there was statistical difference （P〈0.01）. Conclusions Bile reinfusion via the nasojejunal tube may facilitate the recovery of liver function after biliary tract surgery.