M'Koma Amosy E, Longo Walter E
Department of Surgery, Center for Surgical Sciences (CFSS), Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden.
Int J Colorectal Dis. 2007 Mar;22(3):283-8. doi: 10.1007/s00384-006-0130-9. Epub 2006 Apr 1.
Transient homeostatic derangements are found after major abdominal and pelvic surgery. We observed elevated liver function tests (LFTs) after restorative proctocolectomy (RPC). This study was undertaken to determine the etiology and implications of elevated LFTs before RPC and postoperatively.
One hundred and thirty-four RPC-patients were prospectively evaluated for LFT abnormalities. Patients were assigned to two groups: hand-sewn ileal-reservoir after mucosoproctocolectomy (n=83) or stapled anastomosis (n=9), both with loop ileostomy and stapled anastomosis without loop ileostomy (n=42). Serum alanine-aminotransferase (ALAT) and alkaline phosphatases (ALP) were assessed preoperatively, 1-10 weeks postoperatively before loop ileostomy closure and 1-10 weeks after ileostomy closure. These findings were correlated with anesthesia time, transfused blood volume, perioperatively administered drugs, and length of the diverted bowel while having a loop ileostomy.
A large number of patients showed initial elevated serum ALAT and ALP levels, suggesting liver cell damage. There was a substantial and significant increase in ALAT and ALP in the first postoperative week. The values normalized within 2 weeks for the group without loop ileostomy, but not until after loop ileostomy closure in first group. A significant correlation as to length of diverted bowel (<0.05) while having a loop ileostomy was noted. When the length of diverted bowel was more than 105 cm, liver enzymes were higher than baseline levels (p<0.05) until after closure.
Patients may develop elevated LFTs after RPC; however, its etiology and significance remains unclear. A loop ileostomy with RPC seemed to delay the normalization. Consideration of further diagnostic imaging may be indicated to exclude other liver pathology such as sclerosing cholangitis.
在腹部和盆腔大手术后会出现短暂的内环境紊乱。我们观察到在直肠结肠切除术后肝功能检查（LFTs）升高。本研究旨在确定直肠结肠切除术（RPC）术前及术后肝功能检查升高的病因及影响。
对134例接受RPC的患者进行肝功能异常的前瞻性评估。患者分为两组：黏膜直肠结肠切除术后手工缝合回肠储袋组（n = 83）或吻合器吻合组（n = 9），两组均行袢式回肠造口术，以及不行袢式回肠造口术的吻合器吻合组（n = 42）。在术前、术后1 - 10周回肠造口关闭前以及回肠造口关闭后1 - 10周评估血清丙氨酸氨基转移酶（ALAT）和碱性磷酸酶（ALP）。这些结果与麻醉时间、输血量、围手术期用药以及有袢式回肠造口时旷置肠段的长度相关。
大量患者最初血清ALAT和ALP水平升高，提示肝细胞损伤。术后第一周ALAT和ALP有显著且明显的升高。无袢式回肠造口组的数值在2周内恢复正常，但第一组直到袢式回肠造口关闭后才恢复正常。观察到有袢式回肠造口时旷置肠段长度存在显著相关性（<0.05）。当旷置肠段长度超过105 cm时，肝酶高于基线水平（p<0.05），直至关闭后才恢复。
患者在RPC后可能出现肝功能检查升高；然而，其病因和意义仍不清楚。RPC联合袢式回肠造口似乎会延迟恢复正常。可能需要考虑进一步的诊断性影像学检查以排除其他肝脏病变，如硬化性胆管炎。
