J.Jpn. Surg. Soc.. 88(8): 939-946, 1987

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Original article

CLINICAL ANALYSIS OF POSTOPERATIVE HYPERBILIRUBINEMIA FOLLOWING RESECTION OF ESOPHAGEAL CACER

Postoperative hyperbilirubinemia (Bil≧2, II≧15) was observed in 46.9％ of 239 cases of esophageal cancer, since 1969. The incidence increased significantly from 31 to 55.9％ after introducing total parenteral nutrition (TPN) for pre-postoperative nutritional support. In retrosternal reconstraction it was significantly higher (57.8％) than any other operative procedures. Further investigation was done in recent 128 cases since 1979. Postoperative hyperbilirubinemia was observed in 59％. The incidence was not different among operative procedures. It was significantly higher in esophagectomy than in total gastrectomy (28％) and in colectomy (12％). Lower nutritional states and longer operative time were predictive factors.
Patients with higher bilirubin level (group A : ≧3,5) had higher incidence of associated complications than patients with lower bilirubin level (group B : 3.5＞≧2) and patients in control (group C : ＜2). Patients with hyperbilirubinemia alone as a postoperative complication were studied in group A and B. Bilirubin level in both groups reached maximum on 6-7th postoperative days (POD) as γGTP and ALP increased rapidly after 3rd-4th POD. The second elevation of GOT and GPT, and incidence of leukocytosis were marked in group A.
Thus it was conceived that TPN, malnutrition, effects of extensive operation, postoperative cholestatic change, and infection might contribute to postoperative hyperbilirubinemia.

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