【摘要】 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。更多还原

【Abstract】 Objective To analyze the changes of cellular immunity in malignant obstructive jaundice patients with endoscopic retrograde cholangiopancreatography(ERCP).percutaneous transhepaticcholangial drainage(PTCD)and open surgery.Methods A total of 120 patients with malignant obstructive jaundice were selected and they were randomly divided into four groups according to different treatment methods for high- or low-level obstructive jaundice.Fasting venous blood were taken at the day before the operation,one day after the operation,one week after the operation and two weeks after the operation.The levels of LPS,sIL-2R and CD8~+ CD28~- T cells in blood samples were respectively recorded.Blood samples from another 30 healthy donors were tested as controls.Results The levels of LPS and sIL-2R and CD8~+ CD28~- T cells in patients were significantly higher than the controls.At the second week after operation,the levels of these indicators were significantly decreased(P <0.05),but they were still higher than healthy controls.Patients with ERCP treatment had the greatest reduction than the other groups(P <0.05).Conclusion The cellular immunity of malignant obstructive jaundice patients is decreased and ERCP treatment may enable a faster recovery of the immunity.更多还原