经内镜逆行胰胆管造影胆管支架置入术对老年恶性梗阻性黄疸患者免疫炎性反应及肝功能的影响  

The impact of ERCP biliary stent implantation on immune inflammatory response and liver function in elderly patients with malignant obstructive jaundice

作　　者：李俊[1] 罗国松 郑英俊 王学文[1] LI Jun;LOU Guo-song;ZHENG Ying-jun;WANG Xue-wen(Hepatobiliary Pancreatic Spleen Diagnosis and Treatment Center,Zigong Fourth People’s Hospital,Zigong 643000,China)

机构地区：[1]四川省自贡市第四人民医院肝胆胰脾诊疗中心,四川自贡643000

出　　处：《实用医院临床杂志》2024年第2期140-144,共5页Practical Journal of Clinical Medicine

基　　金：自贡市重点科技计划项目(编号:2020YLSF07);四川大学自贡市校地科技合作专项项目(编号:2021CDZG-23)。

摘　　要：目的探讨经内镜逆行胰胆管造影(ERCP)胆管支架置入术治疗老年恶心梗阻性黄疸(MOJ)患者临床疗效及可能作用机制。方法收集2020年7月至2022年6月在我院接受胆管支架置入术治疗的老年MOJ患者102例临床资料,根据胆管支架置入方式分为ERCP组(54例)与PTCD组(48例),比较两组手术成功率与临床疗效、细胞免疫功能、炎性因子、肝功能、不良反应等指标。结果ERCP组低位梗阻患者手术成功率、临床疗效高于PTCD组(χ^(2)=4.193,4.877,P<0.05);CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于PTCD组,CD8^(+)低于PTCD组(P<0.05);血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)低于PTCD组(P<0.05);血清谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBil)、直接胆红素(DBil)低于PTCD组(P<0.05);导管堵塞等并发症7.41%低于PTCD组22.92%(χ^(2)=4.873,P<0.05)。结论ERCP胆管支架置入能够提高手术治疗效果,减少并发症的发生,可能与调节细胞免疫功能、抑制炎症反应、改善肝功能等因素有关。Objective To explore the clinical effect and possible action mechanism of endoscopic retrograde cholangiopancreatography(ERCP)biliary stent implantation in elderly patients with malignant obstructive jaundice(MOJ).Methods Clinical data of 102 elderly patients with MOJ from July 2020 to June 2022 were collected.According to the placement method of biliary stent,the patients were divided into an ERCP group(n=54)and a percutaneous transhepatic cholangiodrainage(PTCD)group(n=48).The success rate of operation,clinical curative effect,cellular immune function,inflammatory factors,liver function and adverse reaction were compared between two groups.Results The low obstruction operation success rate and clinical curative effect in the ERCP group were higher than those in the PTCD group(χ^(2)=4.193 and 4.877,P<0.05).The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were higher while CD8^(+)was lower in the ERCP group than those in the PTCD group(P<0.05).Serum levels of C-reactive protein(CRP),interleukon-6(IL-6)and tumor necrosis factorα(TNF-α)in the ERCP group were lower than those in the PTCD group(P<0.05).Serum levels of AST,ALT,Tbil and Dbil in the ERCP group were lower than those in the PTCD group(P<0.05).The complications such as catheter obstruction in the ERCP group was 7.41%that was lower than 22.92%in the PTCD group(χ^(2)=4.873,P<0.05).Conclusions ERCP biliary stent implantation can improve surgical effect and reduce complications.It may be related to the regulation of cellular immune function,inhibition of inflammatory reaction and improvement of liver function.

关 键 词：恶性梗阻性黄疸 胆管支架置入 经内镜逆行胰胆管造影 免疫炎性反应 肝功能 

分 类 号：R730.5[医药卫生—肿瘤]