A Clinical Study of Hyperbilirubinemia and Pathophysiology after Major Hepatectomy -Comparison with Liver with Obstructive Jaundice, Liver with Cirrhosis and Liver with Normal Function-

Kazuo Hatsuse, Hideki Aoki, Michinori Murayama, Sotoshi Shouno, Nozomi Idota, Shoetsu Tamakuma

First Department of Surgery, National Defense Medical College

In order to clarify changes in bilirubin and pathophysiology after major hepatectomy, we studied patients that underwent hepatic resection of more than 2 segments. We measured serum bilirubin, endotoxin, ammonia and the status of consciousness before and on the lst, 4th and 7th day after surgery. Patients were divided into three groups; the LC group consisted of 7 patients with hepatocellular carcinoma with liver cirrhosis; the OJ group, 5 patients with obstructive jaundice; and the N group, 12 patients whose liver functions were normal. The results were as follows. In the OJ group total bilirubin was significantly higher than that of the LC and N groups, with a predominant amount of direct bilirubin on the 4th and 7th day after operation. Ammonia was high in the OJ and LC groups before the operation, and was significantly higher in the OJ group on the 4th and 7 days after the operation. Endotoxin was high in the LC group before the operation and on the 1st day after the operation, but in the OJ group, endotoxin changed in a way similar to the N group. Hepatic encephalopathy was seen in 2 patients of the OJ group and in 2 patients of the LC group, whose total bilirubin was more than 5 mg/dl, with a predominant amount of direct bilirubin. In 2 patients of the OJ group who suffered from hepatic encephalopathy, endotoxin was more than 2l pg/ml. On the other hand, endotoxin was high even in patients whose postoperative course was uneventful in the LC and N groups. The above data suggested that after hepatectomy the patients with obstructive jaundice were sensitive to endotoxin. and were easily introduced into retardation of jaundice and hepatic encephalopathy.

Key words
hepatic resection, postoperative hyperbilirubinemia, obstructive jaundice, liver cirrhosis, endotoxin

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

Accepted
September 8, 1993

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