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目的探讨经皮肝穿刺胆管内、外引流术在恶性肿瘤致梗阻性黄疸治疗中的意义。方法将我院2000年11月～2006年11月收治的96例恶性肿瘤致梗阻性黄疸病人按胆汁引流途径分成外引流组(41例)和内引流组(55例)。分别于术前1d、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,并与健康对照组进行比较。结果外、内引流组总胆红素(TBIL)分别由术前的(343.54±105.56)μmol/L、(321.19±110.50)μmol/L降为术后1周的(290.56±103.46)μmol/L、(283.72±104.95)μmol/L,两组总胆红素均较术前明显下降(P<0.05),两组间无显著性差异(P>0.05)。TNF-α在外、内引流组分别由术前的(108.58±19.95)μg/L、(109.98±16.24)μg/L降为术后的(104.32±19.59)μg/L、(83.92±13.43)μg/L,内引流组较术前显著改善(P<0.01)。内引流组病人术后外周血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+值较术前无显著变化(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病人全身免疫功能低下,行胆道内引流术后病人细胞免疫功能显著改善。
Objective To investigate the significance of percutaneous transhepatic bile duct internal and external drainage in the treatment of obstructive jaundice caused by malignant tumors. Methods 96 cases of obstructive jaundice from November 2000 to November 2006 in our hospital were divided into external drainage group (41 cases) and internal drainage group (55 cases) by bile drainage. The changes of liver function, serum tumor necrosis factor (TNF-α) and cellular immune function were observed on the first day before operation and one week after operation. The changes of each index before and after operation were observed and compared with the healthy control group. Results The total bilirubin (TBIL) in the internal drainage group decreased from (343.54 ± 105.56) μmol / L and (321.19 ± 110.50) μmol / L to (290.56 ± 103.46) μmol / L , (283.72 ± 104.95) μmol / L, respectively. The total bilirubin in both groups was significantly lower than that before operation (P <0.05). There was no significant difference between the two groups (P> 0.05). The levels of TNF-αin the group of external drainage and internal drainage were decreased from (108.58 ± 19.95) μg / L and (109.98 ± 16.24) μg / L to (104.32 ± 19.59) μg / L and (83.92 ± 13.43) μg / L, the internal drainage group significantly improved compared with preoperative (P <0.01). The levels of CD4 +, CD3 + and CD4 + / CD8 + in peripheral blood T lymphocyte subsets (TLS) in patients with internal drainage were significantly higher than those preoperatively and postoperative CD8 + was significantly lower than that in preoperative drainage (P <0.05) -α and CD4 +, CD3 +, CD8 + and CD4 + / CD8 + in peripheral blood were not significantly different from those before operation (P> 0.05). There was a significant difference between the two groups. Conclusion Percutaneous transhepatic biliary drainage is an effective method for the treatment of obstructive jaundice caused by malignant tumors. Malignant tumors caused by obstructive jaundice in patients with systemic immune function is low, the biliary drainage after the patient’s cellular immune function was significantly improved.