駿河II法外胆汁瘻を造設した胆道閉鎖症術後症例における胆汁排泄,利胆剤効果ならびに抗生物質の胆汁中移行に関する研究

抄録

The purpose of this study is to evaluate the bile flow, its bile content and the effects of choleretics and the biliary excretion of an antibiotic (Cefmetazole) in congenital biliary atresia patients following the construction of Suruga II type enterostomy. The patients were divided into two groups according to their volume of bile flow postoperatively and bile & serum bile acid values. In one group (A : n = 16), bile flow gradually increased, and was above 100 ml/day 6 months after surgery. Total bile acid concentration in bile and serum changed within a certain range in the period of investigation. The logarithmic ratio of bile acid concentration of bile and serum, B/S ratio, was always greater than 0. In another group of patients (B: n = 19), bile flow was below 100ml/day in the same period, serum bile acid concentration fluctuated, but bile acid concentration in bile was consistently below 100nMol/ml and B/S ratio was < 0. Regarding the effect of choleretics, bile acid derivatives (dehydrocholic acid, ursodeoxycholic acid), predonisolone, phenobarbital and cholestyramine were administered to evaluated the change of bile flow in early postoperative period (1W-3M). Relatively favorable effects of bile acid derivatives and predonisolone were demonstrated in group A, but were ineffective in group B. In the late postoperative period (6M-3Y1M) dehydrocholic acid significantly increased bile flow and bile acid excretion in patients with bile flow less than 40ml/kg/day which were originally included in group A. It was exactly correlated with the B/S ratio and was significantly lower in group B. Choleretics stimulated the Cafmetazole excretion in some of group A patients, but no effect in group B. It is concluded that choleretics may stimulate the biliary excretion in a group of patients whree bile flow in 20-40ml/kg/day in the late postoperative period. The excretion of Cefmetazole is similarly related to the logarithmic ratio of bile acid concentration of bile and serum.