Abstract
Hyperbirirubinemia after operation for esophageal cancer is frequently seen, but no etiologic theory has been established as yet. In this experiment the mechanism of postoperative hyperbirirubinemia (PHB) was investigated in term of gut metabolism, and intestinal decontamination was also evaluated in esophageal cancer surgery. In the 19 cases, plasma endotoxin and aminogram were measured perioperatively. PHB was found in 5 of 5 cases with positive plasma endotoxin. Glutamin and alanin were significantly lower in the patients with PHB than those without PHB during operation. These results suggested that lowered glutamin and alanin during surgical stress may be associated with derangement in the intestinal mucosa which induced with breakedown in the gut barrier function. In the next experiment, the effects of intestinal decontamination to the patients with PHB were evaluated. Intestinal decontamination of kanamycin 1200 mg/day lowered the maximal value of total birirubin in this group compared to the control group, though there was no significant difference in the frequency of PHB. From these result, it is concluded that the cause of PHB may be translocation of endotoxin from impared gut mucosa.
