Kimata H, Ohyanagi H, Usami M, Saitoh Y
First Department of Surgery, Kobe University, School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1988 Aug;89(8):1211-22.
The effectiveness of therapeutic plasmapheresis with the biliary decompression was evaluated using animal model in the treatment of obstructive jaundice. Plasma exchange (PE) using fresh frozen plasma was carried out with biliary decompression on canine jaundice model made by means of ligation and resection of bile duct. Routine biochemical analysis was performed following the PE and biliary drainage and the result was compared with the external biliary drainage group. Plasma level of total bilirubin decreased after PE and kept lower level while plasma level of bilirubin in external biliary drainage group decreased slowly. M-GOT and GOT level, those are the indicators of liver cell injury, was lower in PE group. Mitochondrial function of liver cell was evaluated following partial hepatectomy carried out two days after PE with biliary decompression on jaundiced rat. Mitochondrial respiratory control ratio and ADP/O ratio was improved in PE group. The effectiveness of PE is speculated as the combined mechanism of the removal of hepatotoxic factors in the jaundiced plasma and the addition of hepatotrophic factors within the fresh frozen plasma. These results support the effectiveness of PE to shorten the biliary drainage period and to improve the hepatic function for perioperative management.
在阻塞性黄疸的治疗中，使用动物模型评估了治疗性血浆置换联合胆道减压的有效性。在通过结扎和切除胆管制成的犬黄疸模型上，采用新鲜冰冻血浆进行血浆置换（PE）并联合胆道减压。在血浆置换和胆道引流后进行常规生化分析，并将结果与外引流组进行比较。血浆置换后总胆红素水平下降并维持在较低水平，而外引流组胆红素水平下降缓慢。谷丙转氨酶（M-GOT）和谷草转氨酶（GOT）水平，即肝细胞损伤指标，在血浆置换组中较低。在对黄疸大鼠进行血浆置换联合胆道减压两天后进行部分肝切除，评估肝细胞的线粒体功能。血浆置换组线粒体呼吸控制率和ADP/O比值得到改善。推测血浆置换的有效性是去除黄疸血浆中肝毒性因子和新鲜冰冻血浆中添加肝营养因子的联合机制。这些结果支持血浆置换在缩短围手术期胆道引流时间和改善肝功能方面的有效性。
