Study of Pathogenesis and Therapy on Retardation of Jaundice after Hepatectomy for Patients with Obstructive Jaundice

Kazuo Hatsuse, Satoshi Shohno, Nozomi Idota, Michinori Murayama, Yoshihiro Sakai, Noriyasu Komine, Takeyuki Idei, Hideki Aoki, Minoru Kakihara, Shoetsu Tamakuma

First Department of Surgery, National Defense Medical College

Postoperative jaundice is recognized as a sign of hepatic failure after hepatic resection. We examined the pathogenesis and therapy for postoperative jaundice in 6 patients who underwent hepatic resection for bile duct cancer with obstructive jaundice. The preoperative serum maximal total bilirubin level significantly affected the degree of postoperative jaundice, whereas the resection rate and blood loss were insignificant. Five parameters indicating the liver functional reserve (prothrombin time, serum ammonia, serum endotoxin, arterial ketone body ratio, and consciousness level) were measured. The endotoxin was higher and the consciousness level was lower in relation to the increase in jaundice, but the other 3 parameters were not related to jaundice. Positive ratios of the 5 parameters increased with the increase of jaundice. But there was one patient whose positive ratio was only one, in spite of an increase in jaundice. This patient was suspected of having so-called intrahepatic cholestasis. Jaundice derived from liver function impairment is an indication for plasma exchange, which should begin when the positive ratios of the 5 parameters increase, and the total bilirubin is more than 8 mg/dl. For intrahepatic cholestasis, adrenocortical hormone was thought to be an effective treatment.

Key words
obstructive jaundice, postoperative jaundice after hepatic resection, hepatic failure

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

Accepted
March 3, 1993

To read the PDF file you will need Abobe Reader installed on your computer.