恶性阻塞性黄疸患者外周血淋巴细胞IL—2产生及IL—2R表达

恶性阻塞性黄疸患者术后极易发生感染，甚至脓毒血症，本文研究了恶性阻塞性黄疸患者外周血淋巴细胞ＩＬ－２产生及ＩＬ－２Ｒ表达能力的变化。结果显示，阻塞性黄疸患者外周血淋巴细胞ＩＬ－２产生能力明显下降，ＩＬ－２Ｒ表达也明显下降，恶性阻塞性黄疸患者外周血淋巴细胞ＩＬ－２生成能力及ＩＬ－２Ｒ表达受到明显抑制，与良性阻塞性黄疸组相比，差异具有显著性意义（Ｐ＜０．０５）。恶性阻塞性黄疸患者免疫功能明显受抑，可能     

白血病患者外周血IL－2、mIL－2R和TNF－α的检测及意义

４５例白血病患者，采用固相放射免疫分析法（ＲＩＡ）测定其血清白细胞介素２（ＩＬ－２）的水平，以流式细胞仪（ＦＣＭ）检测其外周血单个核细胞（ＰＭＮＣ）上膜白细胞介素２受体（ｍＩＬ－２Ｒ）的表达，用双抗体夹心ＣＥＬＩＳＡ法测定其血清肿瘤坏死固子α（ＴＮＦ－α）的含量。发现急性白血病（ＡＬ）及慢性位细胞白血病原始细胞危象（ＣＭＬ－ＢＣ）患者血清ＩＬ－２和ＴＮＦ－α的水平明显高于正常，ＣＭＬ－ＢＣ尤其急淋变者的ＰＭＮＣ上ｍＩＬ－２Ｒ阳性率较高，并与血清ＴＮＦ－α有关，而与血清ＩＬ－２无关，ｍＩＬ－２Ｒ阳性常提示白血病患者疗效差，预后不良。     

肝癌患者外周血IL—2R检测及其意义

白细胞介素Ⅱ(IL—2)及白细胞介素Ⅱ受体(IL—2R)在人类免疫应答中起着重要作用。IL—2R包括膜表面受体(mIL—2R)及可落性受体(sIL—2R)二种类型。本文对肝癌患者外周血T细胞mIL—2R表达及血清sIL—2R含量进行研究,现将结果报道如下。     

PTCD治疗恶性阻塞性黄疸临床研究

目的 探讨PTCD内、外引流对恶性阻塞性黄疸治疗的临床价值及术后对免疫功能、血浆内毒素的影响。方法在DSA引导下经皮肝穿刺肝内胆管留置引流管,检测治疗前后的血清总胆红素、直接胆红素、T细胞亚群及血浆内毒素水平。结果 治疗前CD3~+、CD4~+、CD4~+/CD8~+均明显低于正常,而血浆内毒素明显高于正常;治疗后CD3~+、CD4~+、CD4~+/CD8~+显著上升,而内毒素水平明显下降。内引流优于外引流,治疗2周后血清总胆红素下降216.5±36.4μmol/L,直接胆红素下降141±36.2μmol/L。结论 PTCD能有效地解除黄疸,提高机体免疫功能,改善症状,延长患者生存期。     

肝癌特异性转移因子对IL—2活性及IL—2R表达的影响

用免疫山羊的淋巴组织经匀浆透析法制备抗肝癌特异性转移因子，并在体外观察其对ＩＬ－２活性及ＩＬ－２４表达的影响。结果显示：肝癌特异性转移因子可明显地增加肝癌患者的ＩＬ－２活性及ＩＬ－２Ｒ表达，而对正常人的ＩＬ－２活性及ＩＬ－２Ｒ表达无影响，正常转移因子对正常人及肝癌患者的ＩＬ－２活性及Ｉ－２Ｒ表达均无影响；特异性转移因子可特异性地促进分泌ＩＬ－２和表达ＩＬ－２Ｒ异常的细胞恢复正常。提示这可能是特异性     

晚期卵巢癌患者外周血sIL－2R的检测及临床意义

应用ＥＬＩＳＡ法对２０例晚期卵巢癌患者外周血可溶性白细胞介素２受体（ＳｏｌｕｂｌｅＩｎｔｅｒｌｅｕｋｉｎ－２Ｒｅｃｅｐｔｏｒ，ｓＩＬ－２Ｒ）进行了测定，并以２５例良性卵巢肿瘤及１５例正常人作对照。结果显示，卵巢癌患者术前ｓＩＬ－２Ｒ明显高于良性肿瘤及正常对照组，且具有显著性差异（Ｐ＜０．０５）；卵巢癌患者经手术后，血ｓＩＬ－２Ｒ含量明显降低（Ｐ＜０．０５），推测卵巢癌患者细胞免疫功能紊乱可能与ｓＩＬ－２Ｒ升高有关。     

恶性阻塞性黄疸患者减黄术前后免疫功能变化的研究

检测１８例恶性阻塞性黄疸患者减黄术前１天，术后１、３、７、１４和２１天免疫功能变化另设２０例良性阻塞黄疸患者为对照。结果显示：总补体、补体Ｃ３增高，ｓＩＬ－２Ｒ术后先上升后下降，而后又再次上升，表明减黄术对改善恶性阻塞性黄疸患者免疫功能有效。     

Internal-External Percutaneous Transhepatic Biliary Drainage for Patients with Malignant Obstructive Jaundice

Purpose: To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD)for patients with malignant obstructive jaundice. Methods: During the period of January 2008 and July 2013,internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During theprocedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed.External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degreeof bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect ofIEPTBD. Results: Twenty newly onset of infection were recorded after procedure and new infectious rate was47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 ofthem (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L beforedrainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp(P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P< 0.05). Conclusions: The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainageefficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients withmalignant obstructive jaundice need to biliary drainage.     

PTC与PTBD在恶性梗阻性黄疸诊断治疗上的应用

本文报告对肿瘤性黄疸病人行PTC86例,PTBD30例的临床体会。指出PTC方法简单、成功率高、合并症少。PTBD治疗梗阻黄疸作用分为术前减黄和姑息外引流两方面。尤其是不需X线设备,床旁体表定位下的PTBD17例,15例成功,更为简便、合并症少,对梗阻性黄疸有治疗价值。作者建议,对肿瘤性黄疸病人采用以下诊治步骤:B超→ERCP→床旁PTBD→经管造影,决定治疗方案为进一步手术治疗或永久带管外引流,提供有力依据。     

Comparison of Infection between Internal-External and External Percutaneous Transhepatic Biliary Drainage in Treating Patients with Malignant Obstructive Jaundice

Purpose: Percutaneous transhepatic biliary drainage (PTBD) is a form of palliative care for patientswith malignant obstructive jaundice. We here compared the infection incidence between internal-externaland external drainage for patients with malignant obstructive jaundice. Methods: Patients with malignantobstructive jaundice without infection before surgery receiving internal-external or external drainage fromJanuary 2008 to July 2014 were recruited. According to percutaneous transhepatic cholangiography (PTC), ifthe guide wire could pass through the occlusion and enter the duodenum, we recommended internal-externaldrainage, and external drainage biliary drainage was set up if the occlusion was not crossed. All patients withinfection after procedure received a cultivation of blood and a bile bacteriological test. Results: Among 110patients with malignant obstructive jaundice, 22 (52.4%) were diagnosed with infection after the procedure inthe internal-external drainage group, whereas 19 (27.9%) patients were so affected in the external drainagegroup, the difference being significant (p<0.05). In 8 patients (36.3%) in the internal-external group infectionwas controlled, as compared to 12 (63.1%) in the external group (p< 0.05). The mortality rate for patients withinfection not controlled in internal-external group in one month was 42.8%, while this rate in external group was28.6% (p< 0.05). Conclusion: External drainage is a good choice, which could significantly reduce the chance ofbiliary infection caused by bacteria, and decrease the mortality rate at one month and improve the long-termprognosis.     

MRCP对恶性梗阻性黄疸的诊断价值

目的探讨磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)对恶性梗阻性黄疸的诊断价值,提高MRCP对恶性梗阻性黄疸的诊断准确性。方法总结80例恶性病变致梗阻性黄疸的MRCP及常规MRI(磁共振成像)的影像学特征,将MRCP诊断结果与手术病理检查结果进行对照,分析MRCP诊断的准确性及各种恶性梗阻性黄疸MRCP的特征性表现。结果 MRCP对恶性梗阻性黄疸的定位诊断及梗阻近端胆管显示率为100.0%;对恶性梗阻性黄疸的的诊断准确率为83.8%,定位、定性诊断特异性高。结论 MRCP对恶性梗阻性黄疸的定位诊断准确率达100.0%;在定性诊断中有重要地鉴别诊断价值;能明显提高对恶性梗阻性黄疸的诊断准确率。     

经内镜胆道支架置入内引流术治疗恶性梗阻性黄疸的疗效分析及其对细胞免疫功能的影响

[目的]探讨经内镜胆道支架置入内引流(ERBD)术治疗晚期恶性梗阻性黄疸的临床疗效及其对细胞免疫功能的影响。[方法]收集2009年1月至2012年12月间接受ERBD术的晚期恶性梗阻性黄疸患者的临床资料并随访。[结果]58例中51例成功置入支架,成功率为87.9%。支架置入组患者术后黄疸逐渐消退,皮肤瘙痒等症状明显缓解或消失,术后3d、1周血清TB、DB、AST、ALT、ALP、GGT各项指标与术前相比均明显下降(P均<0.05)。术后细胞免疫功能逐步改善,与术前比较术后2周的CD3+、CD4+、CD4+/CD8+水平明显升高(P均<0.05)。[结论]ERBD术治疗恶性胆道梗阻疗效确切,同时能一定程度地改善患者细胞免疫功能,对提高患者生存质量,延长生命具有较满意效果。     

122例恶性梗阻性黄疸患者介入引流术后总胆汁酸检测的意义

[目的]观察恶性梗阻性黄疸患者于经皮肝穿刺胆道造影及引流术（PTCD）术后血清总胆汁酸（TBA）、总胆红素（TBL）及直接胆红素（DBL）的变化。[方法]122例恶性梗阻性黄疸患者PTCD术前1d及术后第3d至4周内作TBA、TBL、DBL检测。[结果]PTCD术前TBA（131．8±76．6μmol／L）与TBL（416．0±127．5μLmol／L）、DBL（300．4±86．9μmol／L）有良好相关性（r值：0．358、0．379，P〈0．05）；术后3dTBA下降明显（15．9±22．6μmol／L），与术前（131．8±76．6μmol/L）比较有显著性差异（P〈0．01）。[结论]血TBA可作为检验PTCD术后黄疸引流是否有效的可靠指标。     

PTC下胆道活检诊断恶性阻塞性黄疸的临床应用

目的　探索PTC下胆道活检的可行性和敏感性 ,获取病变胆管的组织病理学 ,指导临床治疗。方法　 19例恶性阻塞性黄疸 ,在行PTCD(经皮经肝穿刺胆道内外引流术 )减黄术中 ,PTC下胆道活检 ,进行组织病理学检查。结果　 19例患者中有 18例获得组织病理学诊断 (敏感性 ,94 74% )。病理报告为胆管癌n =13 ,胰腺癌n =2 ,转移瘤n =2 ,肝细胞癌n =1,阴性结果n =1,阳性结果率为 94 74%。结论　PTC胆道活检是一种准确可靠的获取组织病理学检查途径     

药物干预降低恶性梗阻性黄疸行PTCD术后急性胰腺炎40例临床分析

[目的]分析恶性梗阻性黄疸患者行PTCD前后应用药物进行预处理以减少术后急性胰腺炎的发生。[方法]对40例高龄、低位恶性肿瘤所致梗阻性黄疸患者,行DSA引导下VrCD胆道支架植入及肝外引流管植入治疗。分为对照组及药物预处理组,每组20例。对照组术前、术后不行预防性用药：药物预处理组患者术前1h预防性皮下注射醋酸奥曲肽0．1mg,术后继续皮下注射醋酸奥曲肽0．1mg,每8h1次,连续3d。分别于术前、术后24h、48h及72h观察两组患者症状体征,复查血、尿淀粉酶及胰腺CT情况。[结果]72h内药物预处理组与对照组恶心呕吐情况无差异（P〉0．05）;腹痛及腹膜炎情况药物预处理组轻于对照组（P〈0．05）;血淀粉酶升高例数药物预处理组明显多于对照组（P〈0．01）;尿淀粉酶升高例数药物预处理组明显多于对照组（P〈0．05）;术后72h内腹部CT阳性例数药物预处理组6例、对照组1例（P〈0．05）;药物预处理组术后确诊胰腺炎1例,对照组7例（P〈0．05）。[结论]针对高龄、低位恶性梗阻性黄疸患者行PTCD治疗时,可于术前及术后预防性应用醋酸奥曲肽。以减少术后发生急性胰腺炎概率或减轻术后急性胰腺餐病情程摩有利干患者术后恢复．