经内镜逆行胰胆管造影支架置入对老年恶性梗阻性黄疸患者的临床疗效和对肝功能及免疫功能的影响

Clinical efficacy and impact on liver and immune function in ERCP stent implantation for elderly patients with malignant obstructive jaundice

摘要:

目的 探讨经内镜逆行胰胆管造影（ERCP）支架置入在老年恶性梗阻性黄疸患者治疗中的临 床应用价值。方法 选取2014 年1 月-2015 年12 月该院所收治的97 例老年恶性梗阻性黄疸患者作为临床 研究对象，根据治疗方式的不同随机分为研究组50 例和对照组47 例。研究组采用ERCP 胆管支架置入术 的临床治疗，对照组采用经皮肝穿刺胆道引流（PTCD）胆管支架置入术的临床治疗，并分别对两组患者的 手术治疗情况、临床症状改善情况、肝功能变化情况、免疫功能变化情况以及并发症发生情况进行分析。 结果 与对照组相比，研究组手术成功率96.00%（48/50）略高于对照组96.31%（44/47），但差异无统计学意 义（P>0.05）；研究组总有效率94.00%（47/50）明显高于对照组80.85%（38/47），差异有统计学意义（P <0.05）； 研究组治疗2 周后总胆红素（TBIL）、直接胆红素（DBIL）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱 性磷酸酶（ALP）和谷氨酰转移酶（GGT）均显著改善[TBIL（110.24±60.05）μmol/L，DBIL（82.43± 46.19）μmol/L，ALT（86.79±39.30）IU/L，AST（53.65±35.81）IU/L，ALP（216.83±127.74）IU/L，GGT （196.52±100.64）IU/L]，差异均有统计学意义（P <0.05）；研究组治疗后CD3+、CD4+ 和CD4+/CD8+ 的水 平与对照组相比均明显提高[CD3+（70.24±5.62）%，CD4+（37.74±3.85）%，CD4+/CD8+（1.35±0.12）]，而 CD8+ 的水平则明显降低[CD8+（27.96±3.14）%]，差异均有统计学意义（P <0.05）；研究组并发症总发生率 8.00%（4/50），与对照组相比明显降低，差异有统计学意义（P <0.05）。结论 经ERCP 支架置入对于老年恶 性梗阻性黄疸患者手术治疗效果提高明显，以及对肝功能和免疫功能的改善均具有十分重要的临床意义。

Abstract:

Objective To probe into the clinical application value of ERCP stent implantation in treatment of elderly patients with malignant obstructive jaundice. Methods From January 2014 to December 2015, 97 elderly patients with malignant obstructive jaundice were selected in our hospital as study objects. According to the different treatment, the patients were divided into study group (n = 50) and control group (n = 47) randomly. The patients in study group were treated with ERCP biliary stent implantation. The patients in control group were treated with PTCD biliary stent implantation. The surgical treatment, clinical symptoms, liver function, immunologic function and incidence of complication of the patients between the two groups were compared and analyzed. Results Compared with control group, the patients in study group, the rate of successful operation was 96.00% (48/50), there was increased, but the differences were not significant statistically (P > 0.05); the patients in study group, total efficiency rate was 94.00% (47/50), there were increased significantly, the differences were significant statistically (P < 0.05); the patients in study group after 2 weeks treatment, TBIL were (110.24±60.05) μmol/L, DBIL were (82.43 ± 46.19) μmol/L, ALT were (86.79 ± 39.30) IU/L, AST were (53.65 ± 35.81) IU/L, ALP were (216.83 ± 127.74) IU/L, GGT were (196.52 ± 100.64) IU/L, there were improved significantly, the differences were significant statistically (P < 0.05); the patients in study group after treatment, the levels of CD3+ was (70.24 ± 5.62)%, CD4+ was (37.74 ± 3.85)%, CD4+/CD8+ was (1.35 ± 0.12) and CD8+ was (27.96 ± 3.14)%, there was reduced significantly, the differences were significant statistically (P < 0.05); the patients in study group, the incidence of total complication was 8.00% (4/50), there was decreased significantly, the differences were significant statistically (P < 0.05). Conclusion ERCP stent implantation has very important clinical significance in improving the treatment effect, liver function and immune function for elderly patients with malignant obstructive jaundice.