恶性梗阻性黄疸经皮肝穿刺胆管内外引流术前后T淋巴细胞亚群、肿瘤坏死因子变化及其意义

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

目的探讨经皮肝穿刺胆管内外引流术对恶性梗阻性黄疸(MOJ)患者免疫功能的影响。方法将我院2000年11月至2007年3月收治的108例恶性肿瘤致梗阻性黄疸患者按胆汁引流途径分成2组:外引流组52例,内引流组56例。分别于术前1 d、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,与健康对照组进行比较。结果外、内引流总胆红素(TBIL)分别由术前(344.55±106.57)、(322.20±111.51)μmol/L降为术后1周的(291.57±104.47)、(284.73±105.96)μmol/L,两组总胆红素均较术前明显下降(P<0.05),两组间差异无统计学意义(P>0.05)。TNF-α在外、内引流组分别由术前的(109.59±20.96)、(110.99±17.25)ng/L降为术后的(105.33±20.60)、(84.93±14.44)ng/L,内引流组较术前显著改善(P<0.01);内引流组患者术后外周血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^+与术前比较,差异无统计学意义(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全身免疫功能低下,胆道内引流后细胞免疫功能显著改善。

To study the influence of percutaneous transhepatic external and internal biliary drainage on the immunity function of patients with advanced malignant obstructive jaundice （MOJ）. Methods 108 cases of obstructive jaundice caused by malignant tumor in our hospital from November 2000 to March 2007 were divided two groups according to the different ways of biliary drainage： external drainage group （52 cases） and internal drainage group （56 cases）. Liver function, serum TNF- α and cellular function were examined one day preoperation and one week postoperation. Results In the external and internal drainage groups, tαal bilirubin was decreased from （ 344.55 ± 106.57 ） μmoll/L and （ 322.20 ± 111.51 ） μmol/L before operation to （ 291.57 ± 104.47 ） μmol/L and （ 284.73 -± 105.96 ） μmol/L after operation respectively （ 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 （ 109.59 ± 20.96 ） ng/L and （ 110.99 ± 17.25） ng/L preoperation to （ 105.33 ±20.60） ng/L and （84.93 ± 14.44） ng/L postoperation respectively （ P 〈 0.01 ）. Serum CD4, CD3, CD4/CD8 were nαably increased, but CD8 was notably decreased （ P 〈 0.05 ）. There was no difference in external drainage group before and after operation （ P 〉 0.05 ）. There was significant difference between the two groups. Conclusion Pereutaneous transheparle external and internal biliary drainage is an effective method to treat obstructive jaundice caused by malignant tumor. Immune function was insufficiency in the patients with obstructive jaundice caused by malignant tumor. After internal biliary drainage, cellular immune function can be nαably improved.