不同引流方式对胆管结石伴梗阻性黄疸者减黄效果及免疫的影响

Effects of different drainage methods on effect of reducing jaundice and immunity of patients with bile duct stones associated with obstructive jaundice

摘要:

目的比较不同引流方式对胆管结石伴梗阻性黄疸者减黄效果及免疫的影响。方法选取82 例胆管结石伴梗阻性黄疸患者，随机分为A组与B组，各41 例。A 组采取鼻胆管连接自膨式负压吸引器进行引流，B 组采取鼻胆管连接引流袋。观察两组术后3 d 的引流量，术后不同时刻血清总胆红素（TBIL）及直接胆红素（DBIL）水平平均值，术前1 d、术后第1、3 和7 天的C- 反应蛋白（CRP）、免疫球蛋白指标及T 淋巴细胞亚群。结果①不同时间的胆汁引流量，TBIL 及DBIL 水平，CRP 水平，IgA、IgM 及IgG 水平，CD3+、CD4+、CD8+及CD4+/CD8+差异有统计学意义（p =0.000）；②A 组与B 组的胆汁引流量，TBIL 及DBIL 水平，CRP 水平，IgA、IgM及IgG水平，CD3+、CD4+、CD8+及CD4+/CD8+差异有统计学意义（p =0.000），A组与B组比较胆汁引流量，IgA、IgM、IgG、CD3+、CD4+及CD4+/CD8+更高，TBIL、DBIL、CRP及CD8+更低；③A组与B组的胆汁引流量，TBIL及DBIL 水平，CRP水平，IgA、IgM 及IgG 水平，CD3+、CD4+、CD8+及CD4+/CD8+变化差异有统计学意义（p =0.000）。④A、B 组术后并发症总发生率分别为4.88%和12.20%，差异无统计学意义（p >0.05）。结论鼻胆管联合持续负压吸引可更有效引流胆汁，强化减黄效果，并促进机体免疫力更快恢复，操作简便、安全性高，值得临床推广。

Abstract:

To compare the effect of different ways of drainage on bile duct stones with obstructive jaundice and the effect of immunization. Methods A total of 82 cases of bile duct stones with obstructive jaundice were selected and randomized into group A and group B, 41 cases in each group. The group A had self-expanding negative pressure suction device for drainage, while group B was drained by nasal biliary drainage. The drainage volume at 3 days after operation, the average level of serum total bilirubin (TBIL) and direct bilirubin (DBIL) levels at different time after operation, the levels of C-reactive protein(CRP),immunoglobulin, T lymphocyte subpopulation at 1-d before surgery and 1, 3 and 7-d after surgery were observed between the two groups. Results The levels of bile drainage, TBIL, DBIL, CRP, IgA, IgM, IgG,CD3+, CD4+, CD8+, CD4+/CD8+ were significantly different at different time points (p = 0.000). The levels of bile drainage, TBIL, DBIL, CRP, IgA, IgM, IgG, CD3+, CD4+, CD8+, CD4+/CD8+ were significantly different between group A and group B (p = 0.000). The changes of bile drainage, TBIL, DBIL, CRP, IgA, IgM, IgG,CD3+, CD4+, CD8+, CD4+/CD8+ in two groups were statistically significant (p = 0.000). The total incidences of postoperative complications were 4.88% and 12.20% in group A and group B, the difference was not statistically significant (p > 0.05). Conclusions Nasal bile duct continuous negative pressure suction can be more effective drainage of bile,and strengthen the effect of reducing jaundice and promote the body's immune system faster recovery, easy to operate and less complications, worthy of clinical promotion.