The Clinical Evaluation of Polymorphonuclear Leukocyte Elastase in Gastrointestinal Surgery

Mitsuyuki Matsumoto, Toshiomi Kusano, Yoshihiro Muto, Tohru Segawa*, Kazuhide Ura*, Kunihide Izawa**, Takashi Kanematsu*

First Department of Surgery, Faculty of Medicine, University of the Ryukyus
Second Department of Surgery* and Emergency Clinic**, Faculty of Medicine, Nagasaki University

A clinical study on the significance of polymorphonuclear leukocyte elasase (PMNE) in gastrointestinal surgery was carried out. The subjects were 24, 7 and 2l patients undergoing pancreatoduodenectomy, total thoracic esophagectomy and total gastrectomy respectively. The plasma levels of PMNE-α₁,- protease inhibitor (API) complex were measured using commercially available enzyme linked immunosorbent assay method and regarded as PMNE values (PMNE-API). The correlations between rises of PMNE-API or PMNE index (PMNE-API [fg/ml]/number of neutrophilic leukocytes [cell/ml]), and several intra-postoperative factors were statistically analyzed. The exaggerated rises of PMNE-API and PMNE index preceded the clinical onset of postoperative multiple organ failure. Postoperative complications induced statistically significant elevation and prolongation of both PMNE-API and PMNE index responses, but appropriate treatment reduced them immediately. PMNA-API and PMNE index responses after uncomplicated pancreatoduodenectomy and total gastrectomy showed that the individual capacity for major surgery was not uniform. The results of this study suggested that postoperative measurement of PMNE-API and PMNE index were objective means by which to evaluate the individual capacity for major surgery, and the beginning, degree and therapeutic responsiveness of postoperative complications.

Key words
polymorphonuclear lenkocyte elastase, postoperative complication, interleukin-6, N-acetyl-D-glucosaminidase, multiple organ failure

Reprint requests
Mitsuyuki Matsumoto First Department of Surgery, Faculty of Medicine, University of the Ryukyus
207 Uehara, Nishihara-cho, Okinawa, 903 JAPAN

Accepted
October 12, 1994

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