The Clinical and Experimental Study of the Retardation-Factor Influencing on the Decrease of Serum Bilirubin after the Alleviation of Obstructive Jaundice

Kazuo Hatsuse, Satoshi Saitou, Takafumi Aozasa, Kenji Tsuboi, Takeyuki Idei, Noriyasu Komine, Hideki Aoki, Shinji Yamamoto, Masayuki Nishida, Minoru Kakihara, Shoetsu Tamakuma

The First Department of Surgery, National Defense Medical College

We examined the retardation-factor influencing on the decrease of serum bilirubin after the alleviation of obstructive jaundice. In a clinical study 43 cases of malignant obstructive jaundice were divided into 3 groups on the basis of the bilirubin reduction rate "b" (good group, b<-0.09: fair group, -0.09≤-0.05: poor group, b≥-0.05) and some factors in the bilirubin reduction rate were examind. In an experimental study hepatic tissue flow, arterial ketone body ratio (AKBR) and endotoxin in the portal vein and systemic circulation were examined in a rat model of obstructive jaundice which was made by bile duct ligation. The clinical results were as follows: In the poor group, the incidence of a positive bacterial culture of the bile and that of leukocytosis were significantly higher than in the good group respectively (p<0.05, p<0.01). Endotoxemia was noted in 2 cases in the poor group. The experimental results were as follows: Endotoxin in the portal vein of the 7-day obstructed group was significantly higher than in the control group (p<0.001). Hepatic tissue flow and AKBR were significantly decreased in the 7-day obstructed group on the other hand (p<0.001). The above data suggested that infection derived not only from the bile duct but also from the portal vein retarded the bilirubin reduction rate in addition to liver dysfunction due to the decrease of the hepatic tissue flow and energy charge in obstructive jaundice.

Key words
obstructive jaundice, percutaneous transhepatic biliary drainage, biliary infection, endotoxin, arterial ketone body ratio

Reprint requests
Kazuo Hatsuse First Department of Surgery, National Defense Medical College
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
June 5, 1991

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