急性 膽道閉鎖後 tube drainage가 血淸 總 cholesterol 및 bilirubin에 미치는 영향

Abstract

[한글]

[영문]

There has been increasing interest to effect of a rapid reduction of serum cholesterol concentration in hypercholesterlemic state and bilirubin concentration in hyperbilirubinemic state after T-tube drainage of bile. The mechanism by which the serum total cholesterol is elevated by obstructive jaundice is not clearly understood, and it is also known that hypercholesterolemia is not necessarily associated with a high dietary intake of cholesterol.

Gonzales-Oddone(1946) has suggested that hypercholesterolemia is caused by direct regurgitation of cholesterol which is synthetized in the liver. However, Van Itallie and Hashim(1963) emphasize that bile acids are the major metabolic end products of cholesterol metabolism and that the enterohepatic circulation of bile acids exerts an important regulatory influence upon cholesterol metabolism. On the other had, Buchwald and Varco(1964) noted reduction of serum total cholesterol concentration after ileal exclusion. And they concluded that it may be caused by decreased cholesterol absorption in the ileum postoperatively, De Palma, Hubay and Insull(1965, 1966) have reported ad rapid and dramatic reduction of the serum cholesterol concentration after T-tube drainage of the common bile duct incident to oprations for biliary tract disease. Significant quantities of cholic acid and cholesterol are lost in T-tube drainage from the common bile duct, and this fact may account for the decrease in serum cholesterol concentration.

The precent investigation was designed to study the influence of biliary decompression on effect of the serum cholesterol and bilirubin after biliary obstruction created experimentally. 12 monglel dogs were used. 8 dogs had distal common bile duct ligation. The dogs were anesthetized with Sodium Pentothal, 25-30

mg/Kg, I.V. and operative field was prepared in aseptic manner. The abdomen was opened by upper midline skin incision and the hepaticoduodenal ligament was idntified and the common bile duct was isolated. The distal common bile cudt was sutured and ligated at near the terminal portion.

After the creation of the complete obstruction, polyethylene tube with its distal end closed was placed in the gall bladder at the time of surgery. This blind end of the poly-ethylene tube was opened at 7th postoperative day in order to decompress the obstructed common bile duct. The rest of 4 dogs had sham operation in same manner in order to control effect of anesthesia and operative stress on the serum cholesterol and bilirubin changes.

The serum total cholesterol was measured by Sidney method and the serum total bilirubin was measured by Mallory and Evelyn method.

The result were as follows:

The control value of the serum cholesterol is 143.1±35.3mg.% and the serum total bilirubin is 0.30, 0.05 mg.%. There was no appreciable changes on serum total cholesterol and bilirubin in sham operation cases. The serum total cholesterol level was rapidly increased from 28th hour and this rapid increasing last until 44th hour after common bile duct ligation. And the slow increasing was noted from 44th hours to 5th day of operation. After the decompression of the obstructed common bile cudt, the serum cholesterol level was rapidly decreased during first 4

hours and returned to normal levels by 72 hours.

The serum total bilirubin level was increased from 24th hours continued up to 52 hours after common bile duct ligation. The maximum level of serum total bilirubin was 8 mg.%. and it does not exceed this level on this experiments.

After release of the common bile duct obstruction, the serum total bilirubin level rapidly decreased from 4 hours and continued to decrease until 60 hours and reached to normal level. From these observation it is clear that the serum total bilirubin changes are more sensitive to changes compared with serum total

cholesterol changes in both common bile duct obstruction and drainage.