ABSTRACT
BACKGROUND: Bile acid signalling and farnesoid X receptor activation are assumed to be essential for liver regeneration. This study was designed to investigate the association between serum bile acid levels and extent of liver regeneration after major hepatectomy. METHODS: Patients who underwent left- or right-sided hemihepatectomy between 2006 and 2009 at the authors' institution were eligible for inclusion. Patients were divided into two groups: those undergoing hemihepatectomy with external bile drainage by cystic duct tube (group 1) and those having hemihepatectomy without drainage (group 2). Serum bile acid levels were measured before and after hepatectomy. Computed tomography was used to calculate liver volume before hepatectomy and remnant liver volume on day 7 after surgery. RESULTS: A total of 46 patients were enrolled. Mean(s.d.) serum bile acid levels on day 3 after hemihepatectomy were significantly higher in group 2 than in group 1 (11·6(13·5) versus 2·7(2·1) µmol/l; P = 0·003). Regenerated liver volumes on day 7 after hepatectomy were significantly greater in group 2 138·1(135·9) ml versus 40·0(158·8) ml in group 1; P = 0·038). Liver regeneration volumes and rates on day 7 after hemihepatectomy were positively associated with serum bile acid levels on day 3 after hemihepatectomy (P = 0·006 and P < 0·001 respectively). The incidence of bile leakage was similar in the two groups. CONCLUSION: Initial liver regeneration after major hepatectomy was less after biliary drainage and was associated with serum bile acid levels. External biliary drainage should be used judiciously after liver resection.
Subject(s)
Drainage/methods , Hepatectomy/methods , Liver Diseases/surgery , Liver Regeneration/physiology , Adult , Aged , Aged, 80 and over , Bile Acids and Salts/blood , Chronic Disease , Female , Humans , Liver Diseases/physiopathology , Male , Middle Aged , Prospective StudiesABSTRACT
A 46-year-old man with chronic myelogenous leukemia (CML) was admitted to our hospital because of high fever. The chest radiographs showed bilateral groundglass-like infiltrates in the perihilar region. Transbronchial lung biopsy (TBLB) and autopsy revealed PAS-positive granular materials characteristic of pulmonary alveolar proteinosis (PAP). He had received interferon-alpha since the time of CML diagnosis. Busulfan had never been administered. Altered cell-mediated immunity was thought to be closely related to the development of PAP.
