Postoperative liver enzyme abnormalities are related to staged restorative proctocolectomy.
Postoperative liver enzyme abnormalities are related to staged restorative proctocolectomy.
复制标题
术后肝酶异常与分期恢复性直肠结肠切除术有关。
DOI：
10.1007/s00384-006-0130-9
复制
发表时间：
2007
影响因子：
2.8
通讯作者：
Longo,WalterE
中科院分区：
文献类型：
--
作者：
M'Koma,AmosyE;Longo,WalterE
背景：大的腹部和骨盆手术后会发现短暂的体内平衡紊乱。我们观察到恢复性直结肠切除术（RPC）后肝功能测试（LFTs）升高。本研究旨在确定RPC术前和术后LFTs升高的病因和意义。方法对134例rpc患者的LFT异常进行前瞻性评价。患者被分为两组：手工缝合回肠贮液后粘膜直结肠切除术（n=83）或吻合器吻合（n=9），两者都有回肠袢造口和吻合器吻合不做回肠袢造口（n=42）。术前、术后1-10周及术后1-10周分别测定血清丙氨酸氨基转移酶（ALAT）和碱性磷酸酶（ALP）。这些结果与麻醉时间、输血量、围手术期给药以及回肠袢造口术时转移肠段的长度有关。结果大量患者出现血清ALAT和ALP水平升高，提示肝细胞损伤。术后第一周ALAT和ALP均有明显升高。未做回肠袢造口术的组在2周内恢复正常，而第一组在回肠袢造口术结束后恢复正常。注意到回肠袢造口术与转移肠长度的显著相关性（<0.05）。当转肠长度大于105 cm时，肝酶高于基线水平（p<0.05），直至关闭。结论RPC术后患者可能出现LFTs升高；然而，其病因和意义尚不清楚。环状回肠造口术与RPC似乎延迟正常化。考虑进一步的影像学诊断，可以排除其他肝脏病理，如硬化性胆管炎。
BackgroundTransient homeostatic derangements are found after major abdominal and pelvic surgery. We observed elevated liver function tests (LFTs) after restorative proctocolectomy (RPC). This study was undertaken to determine the etiology and implications of elevated LFTs before RPC and postoperatively.MethodsOne hundred and thirty-four RPC-patients were prospectively evaluated for LFT abnormalities. Patients were assigned to two groups: hand-sewn ileal-reservoir after mucosoproctocolectomy (n=83) or stapled anastomosis (n=9), both with loop ileostomy and stapled anastomosis without loop ileostomy (n=42). Serum alanine-aminotransferase (ALAT) and alkaline phosphatases (ALP) were assessed preoperatively, 1–10 weeks postoperatively before loop ileostomy closure and 1–10 weeks after ileostomy closure. These findings were correlated with anesthesia time, transfused blood volume, perioperatively administered drugs, and length of the diverted bowel while having a loop ileostomy.ResultsA large number of patients showed initial elevated serum ALAT and ALP levels, suggesting liver cell damage. There was a substantial and significant increase in ALAT and ALP in the first postoperative week. The values normalized within 2 weeks for the group without loop ileostomy, but not until after loop ileostomy closure in first group. A significant correlation as to length of diverted bowel (<0.05) while having a loop ileostomy was noted. When the length of diverted bowel was more than 105 cm, liver enzymes were higher than baseline levels (p<0.05) until after closure.ConclusionsPatients may develop elevated LFTs after RPC; however, its etiology and significance remains unclear. A loop ileostomy with RPC seemed to delay the normalization. Consideration of further diagnostic imaging may be indicated to exclude other liver pathology such as sclerosing cholangitis.