Study of Bilirubin Measurement in Bile Drained from Patients with Obstructive Jaundice

Ken-ichi Kumazawa, Yoichi Otani, Koichi Kubota, Yoshiaki Asami, Shunichi Shiozawa, Toshinori Oishi, Shunsuke Haga, Tetsuro Kajiwara

Department of Surgery, Tokyo Women's Medical College, Daini Hospital

Patients with obstructive jaundice often have complications such as postoperative hepatic insufficiency. In this regard, to ensure precise evaluation of preoperative liver function, we determined the level of bilirubin per day in drained bile (V.Bil) in 68 patients who underwent biliary drainage, and examined the usefulness of this parameter as an index of liver function. V.Bil was 279±171 mg/day on average, showing a close correlation with the serum bilirubin decreasing rate "b", ICG disappearance rate and maximal removal rate (p<0.001). Eight patients underwent resection of two or more hepatic segments, and 2 of them died of postoperative hepatic insufficiency. In these 2 patients, V.Bil was distinctly different from those in patients surviving after surgery. Analysis of factors affecting V.Bil revealed that age, biliary infection and site of obstruction influenced V.Bil, regardless of the seurm bilirubin level prior to biliary drainage. Thus, V.Bil is useful for evaluation of liver function in patients with obstructive jaundice. Measurement of this parameter is advantageous in that it is simple and feasible at an early stage, that it allows the use of unilateral drainage, and that it is not affected by renal function.

Key words
evaluation of liver function in obstructive jaundice, bilirubin metabolism, measurement of bilirubin in bile

Reprint requests
Ken-ichi Kumazawa Department of Surgery, Tokyo Women's Medical College, Daini Hospital
2-1-10 Nishi-oku, Arakawa-ku, Tokyo, 116 JAPAN

Accepted
February 9, 1994

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