Fan S T, Wang Q S, Lo C M, Tam Yu K W, Lai E C, Wong J
Department of Surgery, Queen Mary Hospital, University of Hong Kong.
Aust N Z J Surg. 1994 Nov;64(11):759-62. doi: 10.1111/j.1445-2197.1994.tb04534.x.
Impaired hepatic function is a major contributory factor to the high incidence of postoperative morbidity and mortality in patients with malignant biliary obstruction. Dynamic hepatic function tests such as indocyanine green (ICG) retention and aminopyrine breath tests were evaluated in such patients to define whether they were clinically useful for prediction of postoperative morbidity and mortality. Forty-four patients with malignant biliary obstruction undergoing surgery for relief of obstructive jaundice were recruited into the study. Indocyanine green retention and aminopyrine breath tests were carried out in all patients pre-operatively and repeated in 36 patients postoperatively. The ICG retention was abnormal in all patients before surgery and there was significant improvement 2 weeks after surgery (32.8 +/- 2.5% vs 18.3 +/- 2.8%, P = 0.001). The change in ICG retention levels correlated with the serum bilirubin levels but the pre-operative ICG retention value could not predict postoperative morbidity and mortality. The aminopyrine breath test was abnormal in all but one patient. It correlated with pre-operative prothrombin time of the patients before surgery but it did not improve significantly after surgery and was not predictive of postoperative outcome. It is concluded that both ICG retention and aminopyrine breath tests have limited clinical value in the pre-operative evaluation of patients with malignant biliary obstruction.
肝功能受损是恶性胆管梗阻患者术后发病率和死亡率高的主要促成因素。对这类患者进行了动态肝功能测试，如吲哚菁绿（ICG）滞留试验和氨基比林呼吸试验，以确定它们在预测术后发病率和死亡率方面是否具有临床实用性。44例因恶性胆管梗阻接受手术以缓解梗阻性黄疸的患者被纳入研究。所有患者术前均进行了吲哚菁绿滞留试验和氨基比林呼吸试验，36例患者术后重复进行。所有患者术前吲哚菁绿滞留均异常，术后2周有显著改善（32.8±2.5%对18.3±2.8%，P = 0.001）。吲哚菁绿滞留水平的变化与血清胆红素水平相关，但术前吲哚菁绿滞留值不能预测术后发病率和死亡率。除1例患者外，所有患者的氨基比林呼吸试验均异常。它与术前患者的凝血酶原时间相关，但术后无显著改善，也不能预测术后结果。结论是，吲哚菁绿滞留试验和氨基比林呼吸试验在恶性胆管梗阻患者的术前评估中临床价值有限。
