Tsujinaka T, Fujita J, Morimoto T, Ogawa A, Ebisui C, Yano M, Shiozaki H, Monden M, Yamaguchi T, Nakajima H
Department of Surgery II, Osaka University Medical School, Suita, Japan.
Surg Today. 1998;28(11):1119-23. doi: 10.1007/s005950050298.
This study was conducted to investigate the rationale for postoperative hyperbilirubinemia after major surgery. The serum bilirubin values and urinary excretion of bilirubin metabolites (BM) were monitored in 11 patients who underwent esophagectomy via right thoracotomy for esophageal cancer. Both the serum bilirubin values and the urinary excretion of BM increased postoperatively in all patients. The maximum serum bilirubin level in four patients with septic complications, two of whom developed pneumonia and two, anastomotic leakage (group A), was significantly higher at 5.25+/-4.16 mg/dl than in the remaining patients without septic complications (group B), at 2.11+/-0.07 mg/dl. The peak value of urinary BM was 99.5+/-88.2 micromol/day in group A and 23.5 +/-26.7 micromol/day in group B. The correlation between the level of serum bilirubin and urinary BM excretion was found to be significant. Thus, the metabolism of bilirubin was increased by extensive surgical stress and septic insult.
本研究旨在探讨大手术后出现术后高胆红素血症的原因。对11例因食管癌经右胸进行食管切除术的患者，监测其血清胆红素值及胆红素代谢产物（BM）的尿排泄情况。所有患者术后血清胆红素值及BM的尿排泄均增加。4例发生感染并发症的患者（其中2例发生肺炎，2例发生吻合口漏，为A组）的血清胆红素最高水平为5.25±4.16mg/dl，显著高于其余未发生感染并发症的患者（B组），后者为2.11±0.07mg/dl。A组尿BM的峰值为99.5±88.2微摩尔/天，B组为23.5±26.7微摩尔/天。发现血清胆红素水平与尿BM排泄之间存在显著相关性。因此，广泛的手术应激和感染性损伤会增加胆红素的代谢。
