原发性肝癌切除术后血清胆红素变化规律的临床观察

A Current Observation of the Law of Postoperative Serum Bilirubin Changes in Patients with Primary Liver Cancer

目的 了解原发性肝癌切除术后患者血清胆红素的变化规律。方法 将 3 3 8例患者分为肝功能代偿组和肝功能代偿不全组 ,术后均间断检测血清总胆红素和直接胆红素 ,并作出血清胆红素随时间变化的曲线。结果 肝功能代偿组 2 96例 ,术后胆红素变化平稳 ,第 3天达峰值 ,第 11天恢复至正常水平。肝功能代偿不全组 42例 ,术后第 1天胆红素明显升高 ,第 2天即出现第1个峰值 ,波动较大 ,术后 2周仍未能恢复至正常范围 ,可在 2 6.0 μmol/L以上持续超过 1周。 2组比较有显著性差异。 结论 原发性肝癌患者肝切除术后 ,通常情况下总胆红素在第 3天达峰值 ,以后逐渐下降 ,第 11天恢复至正常水平以下。如发现胆红素峰值前移 ,且在较高水平波动 ,第 11天仍未恢复正常 ,须考虑有肝功能代偿不全 ,应预防肝功能衰竭发生。

Objective To investigate the law of postoperative serum bilirubin changes in patients with liver function completely and incompletely compensative.Methods 338 patients were allocated to postoperative liver function completely or incompletely compensative group.Total and direct bilirubin in serum were determined every day after liver resection.Results A significant difference in postoperative serum bilirubin changes was observed between two groups.The postoperative serum bilirubin relatively stably changed,reached the peak value on the third day,and then decreased to normal on the 11th day in liver function completely compensative group.But in the other group the postoperative serum bilirubin reached the first peak value on the second day,severely fluctuates and did not arrive at the normal value on the 14th day.Conclusion After liver resection the serum bilirubin generally changes stably in the primary cancer patients,it reaches the peak value on the third day,and then decreases to the normal on the 11th day.Otherwise liver function failure should be considered and the measures to prevent the liver function failure should be taken.