Conolly W B, Belzer F O, Dunphy J E
Gut. 1969 Aug;10(8):623-7. doi: 10.1136/gut.10.8.623.
Acute obstruction of the extrahepatic ducts causes gross proximal duct dilatation, and elevated levels of ornithine carbamyl transferase, bilirubin, and alkaline phosphatase. Slow progressive obstruction causes variable proximal duct dilatation and in these cases bilirubin, alkaline phosphatase, and ornithine carbamyl transferase return to normal, despite the presence of severe though incomplete obstruction of the common duct and microscopic findings of biliary cirrhosis. In the early phases, ornithine carbamyl transferase is a slightly more sensitive indicator of biliary obstruction than alkaline phosphatase or bilirubin, but the values still return to normal in the face of a persistent stricture. If a patient who has previously had common duct surgery develops recurrent episodes of fever which suggest cholangitis, it should be assumed that he has a recurrent stricture, even though a cholangiogram and liver function may be normal or only slightly altered. A delay until the liver function studies show consistently raised levels may result in severe biliary cirrhosis and decreased hepatic reserve.
肝外胆管急性梗阻会导致近端胆管明显扩张，以及鸟氨酸氨甲酰转移酶、胆红素和碱性磷酸酶水平升高。缓慢进行性梗阻会导致近端胆管不同程度的扩张，在这些情况下，尽管存在胆总管严重但不完全梗阻以及胆汁性肝硬化的微观表现，胆红素、碱性磷酸酶和鸟氨酸氨甲酰转移酶仍会恢复正常。在早期阶段，鸟氨酸氨甲酰转移酶作为胆管梗阻的指标，比碱性磷酸酶或胆红素稍敏感一些，但面对持续的狭窄，其值仍会恢复正常。如果曾接受胆总管手术的患者出现提示胆管炎的反复发热发作，即使胆管造影和肝功能可能正常或仅有轻微改变，也应假定其存在复发性狭窄。等到肝功能检查显示持续升高时再处理，可能会导致严重的胆汁性肝硬化和肝脏储备功能下降。
