<Original Articles>Noticeable Hyperbilirubinemia Following Major Hepatectomy in Patients with Biliary Tract Carcinoma

Abstract

Serum bilirubin concentrations were examined in patients who received hepatectomy for biliary tract carcinoma. They were divided into two groups according to the presence or absence of preoperative obstructive jaundice (POJ): the POJ group (n = 14) and non-POJ group (n = 10). The POJ group underwent percutaneous transhepatic drainage to delineate jaundice before definitive surgery. Total bilirubin concentration in the POJ group had increased at 1, 3, 5, 7 and 14 days after operation compared to the non-POJ group; the direct bilirubin level had increased at 1, 3, 5 and 7 days, and the indirect bilirubin level had increased at 1 and 3 days. Liver functional data before and 14 days after the operation were similar for the two groups. The incidence of cholangitis was higher in the POJ group than in the non-POJ group. Blood loss was greater in the POJ group than in the non-POJ group. The morbidity rate in the POJ group was higher than that in the non-POJ group. These results suggest that characteristic hyperbilirubinemia developed after major hepatectomy in patients with biliary tract carcinoma, and the bilirubin response is evoked by underlying preoperative biliary passing disturbance.

大量肝切除が行われた胆道癌24例を対象に血清ビリルビン濃度の推移を検討した. 対象を術前に閉塞性黄疸を来した群(POJ 群, 14例)と閉塞性黄疸を来さなかった群(non-POJ群, 10例)とに分配した. POJ 群には術前に減黄の目的で胆道ドレナージを施行した. 総ビリルビン濃度は手術直前に群間差を認めなかったが, 術後 1, 3, 5, 7, 14 病日に POJ 群で高値を示した. 直接ビリルビン濃度は術後 1 3, 5 7 病日, 間接ビリルビン濃度は術後 1, 3病日に POJ 群で高値となった. 肝機能指標は手術直前及び術後14日間で群間差を認めなかった. 胆管炎の頻度は POJ 群で高率であった. 出血量と合併症は POJ 群で多く見られた. これらの所見から, 胆道癌に対する大量肝切除後には特徴的な高ビリルビン血症が発症すること, そうしたビリルビン反応は術前から併存する胆道の通過障害に由来することを推定した.