日本消化器外科学会雑誌第31巻第7号
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1 Key words: obstructive jaundice, biliary drainage, bile refeeding, hepatectomy
2 Fig. 1 Animal models a: experiment I b: experiment 2 silicon tube
3 Fig. 2 Experimantal design Sham Ope J - l r bile duct Zweeks 48hou6 cannulation HX+BD S - zweeks bile duct 48hou6 cannulation BP HX L l. 4 t r S bile duct zweeks iday-48hours cannulation BD HX S l r r zweeks - 5days -48houm a : experiment I duodenostomy saline infusion HX S z weeks 5oays 4d hours - A -i! z weeks 5days 4g hours bile duct cannulation 8D duodenostomy saline infusion HX S I!!! weeks Sdays hou* bile duct cannulation BD duodenostomy bile refeeding HX S r l, l ' l b : experiment 2
4 Fig. 3 Liver chemistry tests Fig. 4 Energy charge and mitotic index at 48 hours after hepatectomy energy charge mitotic index ' + r * ---1
5 Fig. 5 Changes in plasma hyarulonic acid and endotoxin concentration hyarulonic acid endotoxin nglml pg/ml Fig. 6 Liver chemistry tests ALT
6 Alb Fig. 7 Serum albumin and total cholesterol T-Chote myloogbwhr
7 liver weight (g) mean + SD TOVoliver remnant liver NS : not significant Table I Positive rate of becterial culture and plasma endotoxin concentration positive rate of bacterial culture in bile and mesenteric lymphnodes at 48 hours after hepatectomy plasma endotoxin concentration just before and at 48 hours after hepatectomy prehx
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11 nal biliary drainage, unlike external drainage, does not suppress the regeneration of cholestatic rat liver after partial hepatectomy. He- patology 20: , ) Clements WDB, McCaigue M, Erwin P et al: Biliary decompression promotes Kupffer cell recovery in obstructive jaundice. Gut 38 : 92b- 93r, 1996 Effect of Preoperative Biliary Drainage on Major Hepatectomy in Rats with Obstructive Jaundice Hideki Aoki Department of Surgery I, National Defense Medical College To determine the effectiveness of preoperative biliary drainage (BD) on major hepatectomy in rats with obstructive jaundice, liver chemistry, plasma endotoxin concentration, energy charge and mitotic index were studied initially in jaundiced rats with or without preoperative BD and sham-operated. At 4g hours after hepateciomy, the energy charge in the group without BD was significantly lower than in the sham-operated group. The mitotic index in the group without BD was significantly lower than in the sham-operated group, and it gradually increased in accordance with the duration of BD. However, bacterial infection appeared to be the problem in the group with BD. Then the effects of bile refeeding during BD on bile flow, mitotic index and bacterial infection before and after hepatectomy were studied. In the bile refed group, bile flow and biliary bilirubin excretion were significantly greater than in the saline fed group and the serum bilirubin concentration just before hepatectomy in the bile refed group was markedly decreased. The mitotic index in the bile refed group was greater than in the saline fed group and it was almost the same as in the sham-operated group. There were no differences in the Dositive bacterial culture rates in the bile and mesenteric lymph nodes between the bile- and saline-fed groups. These results suggest that preoperative biliary drainage is indispensable for major hepatectomy with obstructive jaundice. And bile refeeding during biliary drainage may play a role in preventing liver failure after hepatectomy with obstructive jaundice. Reprint requests: Hideki Aoki The 13th Division Headquarter, Army Surgeon 2-1 Kotobuki, Kaita, Akigun, Hiroshima, JAPAN
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