经皮肝穿刺胆管内外引流术在恶性肿瘤致梗阻性黄疸治疗中的意义

The significance of percutaneous transhepatic external and internal biliary drainage in treating obstructive jaundice caused by malignant tumor

目的探讨经皮肝穿刺胆管内、外引流术在恶性肿瘤致梗阻性黄疸治疗中的意义。方法将我院2000年11月～2006年11月收治的96例恶性肿瘤致梗阻性黄疸病人按胆汁引流途径分成外引流组(41例)和内引流组(55例)。分别于术前1d、术后1周检测肝功能、血清肿瘤坏死因子(TNF-α)及细胞免疫功能指标,观察各指标术前、术后的变化,并与健康对照组进行比较。结果外、内引流组总胆红素(TBIL)分别由术前的(343.54±105.56)μmol/L、(321.19±110.50)μmol/L降为术后1周的(290.56±103.46)μmol/L、(283.72±104.95)μmol/L,两组总胆红素均较术前明显下降(P<0.05),两组间无显著性差异(P>0.05)。TNF-α在外、内引流组分别由术前的(108.58±19.95)μg/L、(109.98±16.24)μg/L降为术后的(104.32±19.59)μg/L、(83.92±13.43)μg/L,内引流组较术前显著改善(P<0.01)。内引流组病人术后外周血T淋巴细胞亚群(TLS)CD4+、CD3+、CD4+/CD8+值较术前明显增高,术后CD8+则明显低于术前(P<0.05);而外引流组TNF-α及外周血CD4+、CD3+、CD8+、CD4+/CD8+值较术前无显著变化(P>0.05),两组间存在明显差异。结论经皮肝穿刺胆道引流术是治疗恶性肿瘤致梗阻性黄疸有效的方法。恶性肿瘤致梗阻性黄疸时病人全身免疫功能低下,行胆道内引流术后病人细胞免疫功能显著改善。

Objective To study the significance of percutaneous transhepatic external and internal biliary drainage in treating obstructive jaundice caused by malignant tumor. Methods Ninety-six cases of obstructive jaundice caused by malignant tumor in our hospital from November 2000 to November 2006 were divided two groups according to the different ways of biliary drainage： external drainage group（41 cases） and internal drainage group （55 cases）. Liver function, serum TNF-α and cellular immune function were examined on day 1 preoperation and one week postoperation. The changes of the indexes were observed before and after operation and compared with those in control group. Results In the external and internal drainage groups, total bilirubin was decreased from （343. 54± 105. 56）μmol/L and（321.19 ± 110. N））μmol/L to（290. 56 ± 103. 46） μmol/L and （283. 72 ± 104. 95） μmol/L after operation respectively, which were significantly lower than preoperation（P〈0.05）, but there was no significant difference between the two groups（P〉0. 05 ）. TNF-α in external and internal groups was decreased from（108. 58 ± 19. 95）μg/L and（109. 98 ±16. 24）μg/L preoperation to（104. 32 ± 19. 59）μg/L and （83. 92 ± 13. 43）μg/L postoperation respectively, and there was significant difference in internal drainage group after operation（P〈0. 01 ）. In internal drainage group, serum CD4^＋ , CD3^＋ ,CD4^＋/CD8^＋ were notably increased after operation as compared with those before operation, but CD8^＋ was notably decreased（P〈0. 05）. In the external drainage group, there was no difference in TNF-α and CD4 ^＋ ,CD3^＋ ,CD8^＋ ,CD4^＋/CD8^＋ （P〉0. 05）before and after operation,but there was significant difference between the two groups. Conclusion Internal and external drainage were effective methods to treat obstructive jaundice caused by malignant tumor. Patients＇ immune function was weak when they suffered obstructive jaundice caused by malignant tumor, but body＇s cellular immune function can be notably improved after internal biliary drainage.