Pathogenesis of Hyperbilirubinemia after Major Hepatectomy -Analysis of Bile Bilirubin Subfractionations by High Performance Liquid Chromatography-

Shuichi Ishiyama, Akira Fuse, Joji Tanaka, Masahiro Urayama, Yukio Igarashi, Koichi Sutoh, Ichiro Hirai, Masaru Tsukamoto

The First Department of Surgery, Yamagata University, School of Medicine

In order to investigate the pathogenesis of hyperbilirubinemia after major hepatectomy, we studied 21 patients with biliary tract cancer. Those patients were divided into three gruops: a non-hepatectomy control group (n=8), and non-icteric (n=8) and icteric (n=5) hepatectomy groups. In the icteric group, the serum bilirubin level was above 2.0 mg/dl even two weeks after surgry. Bile bilirubin subfractionations were anlalyzed by HPLC. The proportions of bilirubin diglucuronide (BDG) decreased on the first postoperative day in all three groups, whereas those of bilirubin monoglucuronide monglucoside (BGG) and monoxyloside (BGX) increased. The grade of this abnormality was most severe in the icteric group among the three groups. In the icteric group, these changes were kept at significant levels compared with both the control and non-icteric groups. These changes could cause difficulty in bilirubin transport across the cell menbrane of hepatocytes so that hyperbilirubinemia might occur after major hepatectomy. The analysis of bile bilirubin subfractionations seemed useful for the evaluation of hyperbilirubinemia after major hepatectomy.

Key words
hyperbilirubinemia, bilirubin conjugates, hepatectomy, bile duct cancer, high performance Iiquid chromatography

Reprint requests
Shuichi Ishiyama First Department of Surgery, Yamagata University School of Medicine
2-2-2 Iida-Nishi,Yamagata, 990-23 JAPAN

Accepted
September 13, 1995

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