| Objective: Biliary obstruction can lead to damages of multisystem organs and liver was the first influenced and the severest impaired. It was found that a lot of liver function markers were abnormal after biliary obstruction and recovered after relief of biliary obstruction. Recently a lot of experimental and clinical studies were performed on the changes of liver function markers before and after relief of biliary obstruction. But it was little known about the changes of liver function markers shortly after acute biliary obstruction, so was the changes of liver function markers after relief of biliary obstruction by endoscopics treatment. The aim of this study was to discuss the influence of acute biliary obstruction on liver by determining the changes of liver function markers before and after relief of acute biliary obstruction and observed the effect of EST and EML on relief of acute biliary obstruction.Methods: 1 Experimental study Sixty male Wistar rats and sixty female Wistar rats weighing 180~220g were used in this study. Rats were randomly placed into four experimental groups: group I (N=30 , sham-operated ),group II (N =30, half an hour after biliary obstruction ), groupIII(N =30, 1 hour after biliary obstruction ), group IV (N =30, 2 hours after biliary obstruction). After an overnight fast, bronchotomy were performed first and a catheter was placed into bronchus under 1% pentobarbital (30mg -kg) intraperitoneal injection anaesthesia. Through an upper midline laparotomy incision, common bile duct was double-ligated (CBDL). Group I only underwent a sham operation that consisted of bronchotomy and laparotomy without CBDL. Group II group III and group IVunderwent CBDL. At the end of the experiment , rats were sacrificed and blood samples were taken from the inferior vena cava. Liver function markers (serum bilirubin , total bile acid, alanine transaminase, alkaline phosphatase , Y -glutamyl transpeptidase )were determined.2 Clinical study Twenty-five patients , 13 men and 12 women with acute biliary obstruction, were studied .The mean age was 52.5 years and the course of disease was from 1 day to 7days. Ten patitens had cholecystectomy previously. All patients underwent endoscopic sphincterotomy(EST) , mechanical lithotripsy (EML )and eight patients also underwent endoscopic nosabiliary catheter drainage (ENBD). Serum bilirubin, alanine transaminase (ALT) total bile acid (TBA), alkaline phosphatase (ALP) and y -glutamyl transpeptidase (GGT) were measured just before and 1st, 3rd and 7th days after releasing from biliary obstruction.Results: 1 Experimental study (1) When compared with group I (sham-operated), the levels of serum bilirubku ALT and TBA increased significantly(P less than 0.01) among group IK III and IV and the differences among group II > group III and group IV were found to be significant (P less than 0.05). The ratio of DBIL/TBIL among group II -, group III and group IV also increased when compared with group I (P less than 0.05),but there was no difference among group IK group III and groupIV. (2) The levels of ALP in group II and group III increased slightly ,but there was no statistical significance when compared with group I . And only the level of ALP in group IV increased greatly when compared with group I (P less than 0.01).2 Clinical study (1) hi all patients , seventeen patients underwent EST and EML and eight patients underwent EST , EML and ENBD. The pain of all patients were relieved after endoscopic treatments. (2) The levels of liver function markers after relief of biliary obstruction decreased significantly (p<0.05) . On the first day after endoscopic treatments, the level of ALT decreased by 39%, TBA decreased by 36%, TBIL decreased by 44%, DBIL decreased by 45%, ALP decreased by 17% and GOT decreased 22%.ON the third day ,ALT decreased by 60%, TBA decreased by 50%, TBIL decreased by 61%, DBIL decreased by 69%, ALP decreased by 33%, GOTdecreased by 40%. On the seventh day, ALT decreased by 79%, TBA decreased b... |
PDF Full Text Request