不同姑息减黄方式对晚期恶性梗阻性黄疸病人免疫功能的影响  

The effects of different palliative jaundice reducing methods on immune function in patients with advanced malignant obstructive jaundice

作　　者：唐锟[1] 隋璐璐[1] 徐刚 张桐 刘小方[1] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院肝胆胰外科,264000

出　　处：《临床外科杂志》2017年第12期919-922,共4页Journal of Clinical Surgery

基　　金：山东省自然科学基金资助项目(No.ER2014HM052);山东省烟台市科技发展计划(2015WS013)

摘　　要：目的对比分析姑息性减黄手术、经皮肝穿刺胆道引流(PTCD)和内镜下胆管内引流术(ERBD)对晚期恶性梗阻性黄疸病人免疫功能的影响。方法晚期恶性梗阻性黄疸病人271例,随机分为姑息性减黄手术组95例、PTCD组92例、ERBD组84例,检测三组病人术前1天、术后第3、7、14天的血清补体C3、C4、免疫球蛋白IgG、IgA、IgM及内毒素水平。结果 (1)术后第7、14天,姑息性减黄手术组的C3、C4与ERBD、PTCD两组比较差异有统计学意义(P<0.05)。(2)术后第3天,姑息性减黄手术组IgG、IgA、IgM与ERBD、PTCD两组比较差异有统计学意义(P<0.05);术后第7天,三组比较差异无统计学意义(P>0.05);术后第14天,姑息性减黄手术组与PTCD、ERBD两组比较差异有统计学意义(P<0.05)。(3)姑息性减黄手术组内毒素术后与术前比较差异有统计学意义(P<0.05);术后第14天,姑息性减黄手术组与ERBD、PTCD组比较差异有统计学意义(P<0.05)。结论姑息性减黄手术组在改善免疫功能方面优于PTCD、ERBD两组,对于晚期恶性梗阻性黄疸病人,能够手术治疗者首先选用手术治疗;对失去手术机会或不能耐受手术者可行PTCD或ERBD缓解梗阻,改善免疫功能,进而延长生存时间和改善生存质量。Objective To study the effects of three treatment methods such as palliative surgery for reducing jaundice,percutneous trnsheptic cholngio dringe（ PTCD） and endoscopic retrograde biliary drainage（ ERBD） on immune function in patients with advanced malignant obstructive jaundice（ MOJ）.Methods A total of 271 patients with advanced MOJ were randomly divided into three groups according to biliary drainage methods： group A-underwent palliative surgery for reducing jaundice,group B-underwent PTCD and group C-underwent ERBD. Multi indexes such as complement C3 and C4,immunoglobulin IgG,IgA and IgM and endotoxin of the patients 1 day before operation as well as 3,7 and 14 days after operation were detected. Results（ 1） The levels of complement C3 and C4 in the group A were increased on the 7 th and 14 th day after operation,and were significantly different when compared with that of group B and group C（ P〈0. 001）.（ 2） The levels of IgG,IgA and IgM in the group A were increased slightly on the 3 rd day after operation when compared with that of pre-operation,there were statistical differences when compared with that of group B and group C（ P〈0. 001）; the levels of IgG,IgA and IgM were decreased in the three groups,and there were no statistical differences（ P〈0. 05）; on the 14 th day after operation,the levels of IgG,IgA and IgM in the group A were significantly decreased than that in group B and group C,and there were significant differences（ P〈0. 001）.（ 3） The level of serum endotoxin in the group A was decreased gradually after operation,and there was statistical difference（ P〈0. 05）. On the14 th day after operation,the level of serum endotoxin in the group A was lower than that in group B and group C,and there were significant differences（ P〈0. 001）. Conclusion For patients with MOJ,who can undergo surgical treatment,it is preferable to use palliative surgery for reducing jaundice. For patients with malignant obstructive jaundice,who have lost the opportunit

关 键 词：梗阻性黄疸 引流术 免疫功能 内毒素 

分 类 号：R730.5[医药卫生—肿瘤]