We have measured the serum levels of total cholic acid (TCA) in 103 samples of obstructive jaundiced patients (OB group) and 83 samples of gallbladder stone patients without jaundice (control group) by enzymeconjugated colorimetric analysis method. The results revealed that TCA level was higher in OB group than in control group (Plt;0. 001) and had postive correlation with total bilirubin, direct bilirubin and alanine aminotransferase in OB group (Plt;0.01 in all). The clinical value of TCA in obstructive jaundice in comparison with alkaline phosphatase is discussed.
ObjectiveTo investigate impact of splenectomy plus pericardial devascularization on liver hemodynamics and liver function for liver cirrhosis patients with portal hypertension. MethodsThe internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of portal vein and hepatic artery of 42 cases of liver cirrhosis with portal hypertension were measured by Doppler ultrasonic instrument on day 1 before operation and on day 7 after operation. The free portal pressures at different phases (after open abdomen, after splenic artery ligation, after splenectomy, and after devasculanrization) were read from the disposable pressure sensor. Twenty-four healthy people through physical examination were selected as control. Results① The free portal pressure of liver cirrhosis patients with portal hypertension was decreased from (29.12±1.40) mm Hg after open abdomen to (22.71±1.21) mm Hg after splenic artery ligation, and further decreased to (21.32±1.12) mm Hg after splenectomy, but increased to (22.42±1.15) mm Hg after devasculanrization, the difference was statisticly different (all P < 0.01). ② Compared with the healthy people, for the liver cirrhosis patients with portal hypertension, the internal diameter, maximum velocity, minimum velocity, and flow volume of portal vein were significantly enlarged (all P < 0.01), which of hepatic artery were significantly reduced (all P < 0.01) on day 1 before operation; On day 7 after operation, the internal diameter of portal vein was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, and mean velocity of portal vein were significantly enlarged (all P < 0.01), but the internal diameter of hepatic artery was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01). For the liver cirrhosis patients with portal hypertension, compared with the values on day 1 before operation, the internal diameter and the flow volume of portal vein were significantly reduced (all P < 0.01) on day 7 after operation; the internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01) on day 7 after operation. ③ The Child-Pugh classification of liver function between before and after surgery had no significant difference (χ2=1.050, P > 0.05). ④ No death and no hepatic encephalopathy occurred, no thrombosis of splenic vein or portal vein was observed on day 7 after surgery. Conclusionsplenectomy plus pericardial devascularization could decrease portal vein pressure and reduce blood flow of portal vein, while increase blood flow of hepatic artery, it doesn't affect liver function.
Objective To investigate whether protease inhibitor (ulinastatin, UTI) can protect liver from ischemiareperfusion injury in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after hepatic inflow occlusion. Methods A prospective randomized control study was designed. Thirtyone HCC patients undergoing hepatectomy after hepatic inflow blood occlusion were randomly divided into the following two groups. UTI group (n=16)， 1×105 units of ulinastatin was given intravenously in operation, then the dosage was continuously used twice a day up to 5 days postoperatively. Control group (n=15), the patients received other liver protective drugs. Liver function, plasma C-reactive protein (CRP) and cortisol level were compared between these two groups. Results The postoperative liver function of the UTI group was significantly improved compared with the control group. For example, on the third postoperative day the aspartate transaminase (AST), alanine transaminase (ALT) and total bilirubin level in the UTI group were significantly lower than those in the control group, respectively (P＜0.05). On the first postoperative day, the plasma CRP concentration in the UTI group was significantly lower than that in the control group(P＜0.01). The plasma cortisol level in the control group markedly increased compared with the level before operation(P=0.046). However, there was no significant difference in the UTI group between before and after operation. Conclusion Ulinastatin can effectively protect liver from ischemia/reperfusion injury in HCC patients undergoing hepatectomy performed after hepatic inflow occlusion. Also, it can relieve the surgical stress for patients.
【Abstract】Objective To study the changes of insulin-like growth factor-1(IGF-1) in serum of patients with obstructive jaundice.Methods The clinical data of 20 patients with obstructive jaundice were collected and the measurement of serum TNFα,ALT, ALP, endotoxin and IGF-1 were performed. Results The serum IGF-1 in obstructive jaundice was significantly lower than that in gallbladder stone(P＜0.01), while endotoxin, TNF-α, ALT，ALP and TB were higher(P＜0.01). After the biliary duct obstruction was removed, the serum IGF1 in obstructive jaundice was significantly higher than that before operation and serum endotoxin， TNF-α, ALT， ALP and TB were significantly lower than that before operation(P＜0.01). A significant negative correlation was found between serum IGF-1 and serum endotoxin in benign obstructive jaundice(r=-0.761, P＜0.01). ConclusionIn obstructive jaundice, endotoxemia can affect the secretion of IGF-1 from liver. IGF-1 can be used as an index to judge the liver function in obstructive jaundice.
ObjectiveTo explore influence of different nutritional approaches on liver function in patients after esophagectomy. MethodsA total of 160 patients with esophageal cancer who underwent surgical treatment were divided into a enteral nutrition (EN) group and a total parenteral nutrition (TPN) group according to different medical staff. There were 80 patients in each group. Two and 7 days postoperatively, albumin (ALB), prealbumin (PA), alanine aminotransferase (ALT) and total bilirubin (TB) of the 2 groups were examined to evaluate liver function. ResultsAbnormities in liver function (ALB, PA, ALT, TB) was common phenomenon in esophageal cancer patients, but there was no statistical difference in ALB, PA, ALT, TB on the 2nd postoperative day between the EN group and the TPN group (P > 0.05). On the 7th postoperative day, liver functions were improved than those on the 2nd postoperative day in the two groups. And frequencies of liver function abnormity in the EN group were significantly lower than those in the TNP group (P < 0.05). ConclusionCompared with TPN, EN has advantages in facilitating hepatic protein synthesis and recovery of liver function after esophagectomy.
Objective To evaluate the changes of liver function after laparoscopic-assisted radical gastrectomy for gastric cancer and analyze related impact factors. Methods Patients with gastric cancer or colon cancer, who underwent radical gastrectomy or hemicolectomy between Jun 2008 and Jun 2010 in General Hospital of PLA, were included in this study. These patients were divided into open gastrectomy （OG group, n=43）, laparoscopic-assisted gastrectomy （LAG group, n=35）, and laparoscopic-assisted hemicolectomy （LAC group, n=23）. The serum AST, ALT, TB, and ALP levels of all patients enrolled on the preoperative day and post operative day （POD） 1, POD3, POD5, and POD7, and related impact factors were analyzed. Results Compared with the preoperative results, serum AST and ALT levels of patients increased until POD5 in both LAG and OG groups （P＜0.05）, and there was no changes in liver function after operation of patients in LAC group （P＞0.05）. In addition to that serum AST and ALT levels of patients in LAG group in POD1 were significantly higher than those in OG group （P=0.035 and P=0.041）， and that serum ALT level of patients in LAG group was significantly lower than that in OG group in POD3 （P=0.048）, serum AST and ALT levels of patients in two groups in the remaining time points were not statistically significant difference （P＞0.05）. The serum AST and ALT levels of patients in LAG group were significantly higher than those in LAC group during 5 d after operation （P＜0.05）.There was no significant changes of serum ALP and TB levels of patients in LAG and OG groups on the before and after operation （P＞0.05）. The increased serum ALT level of gastric cancer patients after operation related to body mass index （BMI, P=0.038）, operative time （P=0.011）, intraoperative hepatic injury （P=0.035）, and abnormal ligation of hepatic artery （P=0.048）, instead of the type of operation （OG vs.LAG, P＞0.05）. Conclusions Gastric cancer patients who underwent radical gastrectomy have transient liver dysfunction, which attributes mainly to direct liver manipulation or abnormal ligation of hepatic artery, but not CO2 pneumoperitoneum. Laparoscopic-assisted radical gastrectomy is feasible and safe to the patients without serious liver damage or other vital organs disorders.
Objective To estimate the relationship between arterial blood ketone body ratio (AKBR) and liver function and to appraise the feasibility of adding AKBR into liver function estimate. MethodsFrom 1994 to 1998, 44 patients with unresectable liver cancer recieved the combined radiochemoembolization with mixed emulsion of phosphorus32 glass microspheres (32PGMS), chemoagent and glycerine or lipiodol, via intraoperative hepatic artery instillation, hepatic artery ligation and operational arterial embolization (HAL+OAE) or transcatheter hepatic artery embolization (TAE). Preoperative and postoperative function and energy change level of the liver were tested by liver function test and AKBR. CT, SPECT, AFP were used to judge the therapy effect; multivariate statistical analysis methods were used to evaluate the correlation between AKBR and liver function. Spearmen rank correlation analysis was used to evaluate whether there was any relationship between AKBR and liver function test, and to evaluate that there was any relationship between AKBR and survival time. ResultsA negative correlation showed between the level of AKBR and liver function. The correlation coefficient of the three level of AKBR before operation and survival time was 0.4409. Conclusion AKBR can well reflect the degree of liver function.
Objective To explore the changes in the serum Cu2+and the indexes for the liver pathology and biochemistry before and after the copper needle retained in the central veins of the rabbit ears. Methods Fortynine New Zealandrabbits were randomly divided into 5 groups: Group A (copper needles retained for 1 d), Group B (3 d), Group C (5 d), Group D (7 d), and Group E (the control group, without any copper needles retained). In each experimental group, there were 10 rabbits, and in the control group there were 9 rabbits. The rabbits in each group were arranged to have their venous blood drawn for determination of theCu2+concentration, and for observation on the changes in the liver biochemicalindexes for 5 times before and after the copper needles were retained in the central veins of the rabbit ears. At the same time, a piece of the liver tissue ineach rabbit was taken for examination of the pathological changes. All the liver samples were given the basic pathological examination; if the liver sample hadsome extraordinary pathological features, the specific pathological examinationwould be given, even using the transmission electron microscope. Results After the copper needles were retained in the central veins of the rabbit ears, the Cu2+concentration increased with the passing time. The concentrations in the groups were 1.40±0.49 μg/ml in Group A, 1.45±0.53 μg/ml in Group B, 2.01±0.40 μg/ml in Group C, 2.38±0.83 μg/ml in Group D, and 1.34±0.45 μg/mlin Group E, respectively. There was a statistically significant difference between Group D and Group E(P＜0.05). There were no significant changes in the ALT and AST levels when compared with those before the copper needles were retained(P＞0.05); however, there was a considerably positive correlation on 1st day (r=0.686, P＜0.05), 5th day (r=0.712, P＜0.05), and 7th day (r=0.768, P＜0.01) when compared with those after the copper needles were retained. The histological examination showed that aseptic inflammation subsided with the time in part of the liver. The Masson staining and the Ag staining showed that there were no obvious changes in the hepatic lobules, with no fibrosis of the liver tissues found under light microscope. Conclusion There are no obvious toxic and side effects on the rabbit liver after the copper needles are retained in its central veins.
Objective To discuss the relationship between the efficiency of bile duct drainage and the postoperative liver functional recovery and the prognosis of hilar cholangiocarcinoma. Methods We studied retrospectively 58 cases of hilar cholangiocarcinoma which entered our department between June 1987 and October 1998. The postoperative liver functional recovery and mortality and morbidity between unilateral (n＝27) and bilateral (n＝31) bile duct drainage groups were compared. Results The liver function in bilateral drainage group was nearly normal within 6 weeks after operation. The ALb level of unilateral drainaged patients recovered gradually to normal after operation, and the TBIL and ALT decrease nearly to the normal range within 6 weeks after operation. The AKP decreased within 2 postoperative weeks, then steadily increased. The differences of perioperative complication rate and mortality of the two groups showed no significance. Conclusion The data showed that the liver function can recover to some extent by unilateral bile duct drainage, and unilateral drainage operations are the choice for hilar cholangiocarcinoma that can not be excised now.
【 Abstract 】 Objective To explore the effect of gamma-globulin in evaluating hepatic functional reservation in patients with liver tumor. Methods Serum protein electrophoresis (SPE) was performed on 30 patients with liver tumor to get gamma-globulin and preoperative Child-Pugh classification. Then the relations between gamma-globulin and preoperative and postoperative Child-Pugh classification were studied. While with gamma-globulin as evaluating standard, the validity compared with Child-Pugh classification were studied. Results The gamma-globulin was lower in classification A patients 〔（ 21.053 3 ± 6.001 4)% 〕 than that in classification B 〔 (28.800 0 ± 8.672 5)% 〕 before operation. While the gamma-globulin 〔 (21.022 0 ± 5.354 6)% 〕 of classification A patients after operation was also lower than that of classification B/C 〔 (29.556 0 ± 7.698 5)% 〕 . These differences were significant (P ＜ 0.05). With gamma-globulin gt;30% as evaluating standard ， the sensitivity and specificity were 80.00% and 96.00%, respectively. Conclusion Gamma-globulin can reflect hepatic functional reservation in patients with liver tumor. Combining gamma-globulin and Child-Pugh classification can evaluate hepatic functional reservation more objectively.