PTCD治疗恶性阻塞性黄疸临床研究

Clinical study on the treatment of malignant obstructive jaundice with FTCD

目的 探讨PTCD内、外引流对恶性阻塞性黄疸治疗的临床价值及术后对免疫功能、血浆内毒素的影响。方法在DSA引导下经皮肝穿刺肝内胆管留置引流管,检测治疗前后的血清总胆红素、直接胆红素、T细胞亚群及血浆内毒素水平。结果 治疗前CD3^+、CD4^+、CD4^+/CD8^+均明显低于正常,而血浆内毒素明显高于正常;治疗后CD3^+、CD4^+、CD4^+/CD8^+显著上升,而内毒素水平明显下降。内引流优于外引流,治疗2周后血清总胆红素下降216.5±36.4μmol/L,直接胆红素下降141±36.2μmol/L。结论 PTCD能有效地解除黄疸,提高机体免疫功能,改善症状,延长患者生存期。

Objective To study the clinical value of bi-directional drainage by PTCD in the therapy of malignant obstructive jaundice and to evaluate the influence on plasma endotoxin and immune function. Method The intrahepatic ducts were punctured and the draining catheters were placed under the guidance of DSA.The serum total bilirubin, direct bilirubin, T-lymhocyte subsets and plasma endotoxin were measured.Results Compared with healthy controls, the patient group had significant decrease in CD3+ , CD4+ , CD4+ /CD8+ before operation. After operation all above indices obviously increased ( P < 0.05) and the level of plasma endotoxin was significantly decreased. The internal drainage group was better than external drainage group. The serum total bilirubin decreased by 216.5 ± 36.4 μmol/L and the serum direct bilirubin decreased by 141 ± 36.2 μmol/L after two weeks of treatment. Conclusion PTCD is an effective procedure for relieving jaundice and improving immune function, thus palliating symptoms and prolonging survival time of the patients.