梗阻性黄疸术后肝内胆汁淤积症的病因及治疗体会

摘要

目的 探讨梗阻性黄疸术后肝内胆汁淤积症的病因和治疗方法.方法 226例梗阻性黄疸经手术解除胆道梗阻后1～14 d内发生的28例肝内胆汁淤积症的病因,在积极抗感染、保肝治疗的基础上,辅以肾上腺糖皮质激素冲击治疗.结果 28例中,胆道感染合并内毒素血症22例(78.6％),围手术期出现一过性低血压5例(17.9％),术后HBV-DNA阳性9例(32.1％),均明显高于正常治愈组(P＜0.05或P＜0.01).经以上方法治疗后27例在术后1～2个月血清胆红素、丙氨酸转氨酶逐渐下降至正常,肝功能明显改善,1例因癌症晚期多器官功能衰竭死亡,治愈率96.4％.结论 梗阻性黄疸术后肝内胆汁淤积症的原因可能为胆道感染、内毒素血症、缺血再灌注损伤、肝细胞乙型肝炎病毒活动等,治疗方面以肾上腺糖皮质激素冲击疗法及腺苷蛋氨酸等护肝治疗有效.%Objective To investigate the etiology and treatment of cholestatic hepatitis after obstructive jaundice operation. Methods The etiology and treatment of 28 patients with cholestatic hepatitis among 226 cases of obstructive jaundice operation were analyzed. Results Of the 28 cases, The ratio of bacterial bile duce infection combined with endotoxemia was 78. 6% (22 cases), that of periop-erative transient hypotension was 17. 9% (5 cases), and that of hepatitis B virus infection was 32. 1% (9 cases), which was significantly higher than in the control group. Twenty-seven patients with postoperative cholestatic hepatitis were cured 1-2 months after operation by the treatments of adrenocorti-cal hormone combined with ademetionine. One patient died of multiple organ failure due to adavanced cancer. Conclusion Bacterial infection of bile duct combined with endotoxemia, ischemic-reperfusion injury and hepatitis B virus infection may cause cholestatic hepatitis after obstructive jaundice operation. For the treatment, adrenocortical hormone combined with ademetionine is recommended.