Evaluation of the Significance of Reducing Jaundice by PTCD in Terms of Changes in Liver Function

Ken-ichi Kumazawa, Shunsuke Haga, Toshihiko Hosokawa, Koichi Kubota, Shunichi Shiozawa, Akira Tsuchiya, Kenji Ogawa, Tetsuro Kajiwara

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

The significance of the reduction of jaundice achieved by PTCD in patients with obstructive jaundice was evaluated through acomparison of data on liver function parameters obtained prior to PTCD and just before surgery in 52 patients with carcinoma of the pancreas or biliary tract who underwent radical surgery following PTCD. The serum total bilirubin level was decreased from 14.3±7.1 mg/dl to 2.4±1.6 mg/dl, with a marked improvement in the levels of GPT and γ-GTP. Disturbed lipid metabolism involving total cholesterol and HDL also tended to be improved. However, there was no change in protein metabolism following PTCD; LCAT, in particular, remained low, moving from 49.6±19.0 nm/ml·hr·37°C prior to PTCD to 46.0±15.4 nm/ml·hr·37°C after PTCD. The jaundice reduction rate "b" and the amount of bilirubin in daily excretory bile, i.e., parameters of the excretory function of the liver, were lower just before surgery than after PTCD. On the other hand, preoperative excretory function and the ability to synthesize protein were found to be lower in patients in whom the postoperative total bilirubin level was over 10 mg/dl than in those with lower bilirubin levels. These findings indicate that PTCD was useful for reducing jaundice, normalizing deviating enzymes and improving the disturbed lipid metabolism, but not for improving protein synthesis or excretory function, which are involved in postoperative jaundice.

Key words
obstructive jaundice, percutaneous trans hepatic cholangio drainage

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

Accepted
December 7, 1994

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