PARTIAL EXTERNAL DIVERSION OF BILE FOR THE TREATMENT OF INTRACTABLE PRURITUS ASSOCIATED WITH INTRAHEPATIC CHOLESTASIS
PARTIAL EXTERNAL DIVERSION OF BILE FOR THE TREATMENT OF INTRACTABLE PRURITUS ASSOCIATED WITH INTRAHEPATIC CHOLESTASIS
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DOI：
10.1016/0016-5085(88)90301-0
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发表时间：
1988-07-01
期刊：
影响因子：
29.4
通讯作者：
WHITINGTON, GL
中科院分区：
文献类型：
--
作者：
WHITINGTON, PF;WHITINGTON, GL
对6例慢性肝内胆汁淤积伴严重瘙痒且药物治疗无效的患者进行了部分胆汁分流至外部吻合口。4例进行性肝内胆汁淤积症和2例肝动脉发育不良患者接受了治疗。随访3-8年。进行性肝内胆汁淤积症患者自手术后无瘙痒。血清胆盐浓度从手术前的218-275 μ M（正常< 10）下降到手术后的< 10 μ M。肝功能和组织学生化检查恢复正常或接近正常。肝动脉发育不良患者术后有持续轻度瘙痒。血清胆盐浓度从153-317 μ M降至25-37 μ M。在生化检查或组织学方面几乎没有改善。进行性肝内胆汁淤积症患者的胆汁量和胆盐转移量较高（7.3-13.0 ml/g. cntdot.）。天和83-137 μ mol/kg·cm-1。天）比具有动脉肝发育不良的那些（3.2- 4.5ml/kg.天和21-36 μ mol/kg·cm-1。天）。进行性肝内胆汁淤积症患者手术后的生活质量非常好，但肝动脉发育不良患者的生活质量并不理想。这些结果表明，部分外胆管引流术可以有效缓解瘙痒，并可能逆转进行性肝内胆汁淤积症患者的肝脏疾病。它应该用于肝动脉发育不良的患者，只有那些致残性瘙痒症。
Partial diversion of bile flow to an external stoma was performed in 6 patients with chronic intrahepatic cholestasis with severe pruritus that has been refractory to medical measures. Four patients with progressive intrahepatic cholestasis and 2 with arteriohepatic dysplasia were treated. Follow-up has been 3-8 yr. Patients with progressive intrahepatic cholestasis have been free of itching since surgery. Serum bile salt concentrations fell from 218-275 .mu.M (normal < 10) before to < 10 .mu.M after surgery. Biochemical tests of liver function and histology returned to normal or near normal. Patients with arteriohepatic dysplasia had persistent mild pruritus after surgery. Serum bile salt concentrations fell from 153-317 to 25-37 .mu.M. There was little or no improvement in biochemical tests or histology. Bile volume and bile salt diverted were higher in patients with progressive intrahepatic cholestasis (7.3-13.0 ml/g .cntdot. day and 83-137 .mu.mol/kg .cntdot. day, respectively) than those with arteriohepatic dysplasia (3.2-4.5 ml/kg .cntdot. day and 21-36 .mu.mol/kg .cntdot. day). The quality of life since surgery has been excellent in patients with progressive intrahepatic cholestasis, but not as optimal in those with arteriohepatic dysplasia. These findings suggest that partial external biliary diversion can provide effective relief from pruritus and perhaps reversal of liver disease in patients with progressive intrahepatic cholestasis. It should be used in patients with arteriohepatic dysplasia only in those with disabling pruritus.