论文部分内容阅读
目的探讨高位梗阻内镜下逆行胰胆管造影术(ERCP)内引流和经皮经肝胆管引流术(PTCD)内引流,以及低位梗阻ERCP内引流和开腹胆肠吻合手术对恶性阻塞性黄疸患者细胞免疫力的影响。方法 选择恶性梗阻性黄疸患者120例,采用抽样分层的方法 ,根据高位和低位梗阻随机分为四组,分别采用不同引流方式治疗,于术前一天和术后第1天、第1周以及第2周抽空腹静脉血,检测血清中脂多糖(LPS)含量、可溶性白介素-2受体(sIL-2R)浓度以及血液中CD8+CD28-T细胞含量,比较患者细胞免疫的变化情况。以正常志愿献血者30例作为对照组。结果四组患者术前血清中LPS含量、sIL-2R浓度以及血液中CD8+CD28-T细胞含量均明显高于对照组;术后2周,四组患者均较术前明显下降(P<0.05),但仍较对照组高(P<0.05),ERCP组较其他两组下降最明显(P<0.05)。结论恶性梗阻性黄疸患者细胞免疫力下降;经ERCP下胆道内支架引流治疗的患者免疫力恢复最快。
Objective To investigate the effect of endoscopic retrograde cholangiopancreatography (ERCP) drainage and percutaneous transhepatic biliary drainage (PTCD) drainage in patients with malignant obstructive jaundice under low obstructive endoscopic retrograde cholangiopancreatography (ERCP) Effect of cellular immunity. Methods One hundred and twenty patients with malignant obstructive jaundice were selected and stratified by sampling method. They were randomly divided into four groups according to the high and low obstruction. The patients were treated with different drainage methods. One day before operation and the first day, the first week after operation, In the second week, fasting venous blood was drawn and serum levels of lipopolysaccharide (LPS), soluble interleukin-2 receptor (sIL-2R) and CD8 + CD28-T cells in blood were measured to compare the changes of cellular immunity. Thirty normal volunteer donors were used as control group. Results The preoperative serum levels of LPS, sIL-2R and the level of CD8 + CD28-T cells in the four groups were significantly higher than those in the control group. Two weeks after operation, the four groups of patients were significantly lower than those before operation (P <0.05 ), But still higher than the control group (P <0.05). The ERCP group had the most obvious decrease (P <0.05) compared with the other two groups. Conclusion The cellular immunity of patients with malignant obstructive jaundice decreased. The patients with ERCP undergoing biliary stent drainage had the fastest recovery of immunity.