DIAGNOSIS OF HEPATIC FAILURE IN EARLY POSTOPERATIVE PERIOD ACCORDING TO THE RESULTS OF BILE ANALYSIS
D.Y. SOSNIN, N.A. ZUBAREVA
Perm State Medical Academy named academician E. Wagner, Perm, RUSSIA
The study of traditional serum markers of hepatodepressive syndrome in the surgical practice does not allow diagnosis of hepatic failure (HF) in the early postoperative period.
A study of cholesterol in bile and its daily excretion in 123 patients with gallstone disease and tumors of extrahepatic tracts and pancreas was carried out within two weeks after external biliary decompression. In 102 (82.9%) patients postoperative period was without complication (comparative group), 21 (17.1%) patients gad HF (main group), progression of which had fatal outcome in 13 (61.9%) cases.
The cholesterol content of bile on the 1-2nd days of postoperative period constituted 8,3±2,1 mg/dl - in the comparative group and 7,1 ± 3,3 mg/dl in the main group. Such low concentration of cholesterol on the first day after surgery is related to disorders in its secretion into bile in the result of surgical trauma and rapid reduction of pressure in the bile passages during their decompression. On the 3 – 4th days level of cholesterol and its daily excretion increased in patients of the comparative group (p <0.001). In patients with HF cholesterol content did not significantly change (p> 0,05) within this period and did not exceed 16 mg/dl. The obtained data allowed to offer “Method of diagnostics of hepatic failure during diseases of hepatopancreatobiliary system in patients with external drainage of bile passages in the postoperative period” (Patent RU No 2087912 C1).
Advantages of the study of cholesterol in the bile as a marker of hepatodepression in the early postoperative period, are justified by its high operational characteristics. Diagnostic sensitivity (DS) of the identification of cholesterol in bile is comparable with DS of the analysis of whole protein and albumin in blood serum, but their diagnostic specificity is almost 2 times lower. The most specific diagnostic serum test of the diagnostics of HF was the study of prothrombine index, however greater percentage of false-negative results does not allow to refer it to early markers of hepatodepression in the postoperative period.
Thus, the study of concentration of cholesterol in the bile helps to early detection of disorders in the synthetic hepatic function after surgical interventions on the biliary tracts.
Date: 2014-12-28; view: 784
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