Abstract
The aim of this article was to study the influence of immunity function of advanced malignant obstructive jaundice (MOJ) treated by percutaneous transhepatic biliary external and internal drainage. Ninety-six cases of MOJ were divided into two groups according to the different ways of biliary drainage. Fifty-two external drainage tubes were placed in 41 cases of percutaneous transhepatic biliary external drainage group and 66 metal stents were placed in 55 cases of percutaneous transhepatic biliary internal drainage group. Liver function, serum TNF-α and cellular function were examined one day before operation and one week after operation and liver function was re-examined two weeks after operation, in order to observe the change and analyze the association among them and compare with the control group. All patients’ conditions were improved after operation. In the percutaneous transhepatic biliary external and internal drainage groups, the total level of bilirubin decreased from (343.54±105.56) μmol/L and (321.19±110.50) μmol/L to (290.56±103.46) μmol/L and (283.72±104.95) μmol/L after operation respectively, which were significantly lower than pre-operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Serum alanine aminotransferase (ALT) of all patients one week after operation was significantly lower than that before operation. TNF-α in percutaneous transhepatic biliary external and internal groups decreased from (108.58±19.95) pg/mL, (109.98±16.24) pg/mL of pre-operation to (104.32±19.59) pg/mL, (83.92±13.43) pg/mL of post-operation respectively, there was notable improvement (P<0.01) in internal drainage group after operation. Patients’ serum CD4, CD3 and CD4/CD8 were notably increased, but CD8 was notably decreased (P<0.05). There was no difference in external drainage group (P>0.05). There was a significant difference between the two groups. Serum TNF-α and ALT had positive correlation. Percutaneous transhepatic biliary internal or external drainage was an effective and important method to treat MOJ. Patients’ immune function was weak when they suffered MOJ, but body’s cellular immune function can be notably improved after internal biliary drainage.
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Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N, Nakai Y, Yamamoto N, Tada M, Yoshida H, Shiratori Y, Kawabe T, Omata M. A prospective randomized study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut, 2004, 53(5): 729–734
Qian X J, Zhai R Y, Dai D k, Yu P. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment. World J Gastroenterol, 2006, 12(2): 331–335
Rossi P, Bezzi M, Rossi M, Adam A, Chetty N, Roddie M E, Iacari V, Cwikiel W, Zollikofer C L, Antonucci F, Boguth L. Metallic stents in malignant biliary obstruction: Result of a multi-center European study of 240 patients. J Vasc Intervent Radiol, 1994, 5(2): 279–285
Schmassmann A, von Gunten E, Knuchel J, Scheurer U, Fehr H F, Halter F. Wall stents versus plastic stents in malignant biliary obstruction: Effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol, 1996, 91(4): 654–659
Chen J H, Sun C K, Liao C S, Chua C S. Self-expandable metallic stents for malignant biliary obstruction: Efficacy on proximal and distal tumors. World J Gastroenterol, 2006, 12(1): 119–122
Li D, Sun J B, Sun H C, Li F, Liu F J, Liu S. The mechanism of hepatic function injury during obstructive jaundice. Chinese Journal of Surgery, 1998, 36(10): 624–626 (in Chinese)
Lau W Y, Leung J W, Li A K. Management of hepatocellular carcinoma presenting as obstructive jaundice. Am J Surg, 1990, 160(3): 280–282
Wang J H, Wang X L, Yan Z P. Abdominal Interventional Radiology. Shanghai: Publishing company of Shanghai medical university, 1998
Stenven N H, Edmund C B, William R J. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg, 1999, 134: 261–265
Welbourn C R B, Young Y. Endotoxin septic shock and acute lung injury: Neutrophil macrophages and inflammatory mediators. Br J Surg, 1992, 79(10): 998–1002
Spivey J R. Glycochenodeoxycho late-induced lethal hepatocellular injury in rat hepatocytes; role of ATP depletion and cytostolic free calcium. J Clin Invest, 1993, 92(1): 17–21
Sheen S M, Chau P, Harris H W. Obstructive jaundice alters kupiffer cell function independent of bacterial translocation. J Surg Res, 1998, 80(2): 205–209
Liu T Z, Lee K T, Chern C L. Free radical-triggered hepatic injury of experimental obstructive jaundice of rats involves overproduction of proinflammatory cytokines and enhanced activation of nuclear factor kappa. Ann Clin lab Sci, 2001, 31(4): 383–390
Erbil Y, Berber E, Ozarmagan S. The effects of sodium deoxycholate, lactulose and glutamine on bacterial translocation in common bile duct ligated rats. Hepatogastroenterology, 1999, 46(29): 2791–2795
Parks R W, Stuart Cameron C H, Gannon C D. Change in gastrointestinal morphology associated with obstructive jaundice. J Pathon, 2000, 192(4): 526–532
Zhang J, Wang Y, Zhang Z T. Endotoxemia in obstructive jaundice, the relationship between serum TNF-α and cellular immune function. Beijing Medical Journal, 2002, 24(6): 388–390 (in Chinese)
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Zhu, L., Chen, X. Change and significance of T-cell subsets and TNF-α in patients with advanced malignant obstructive jaundice treated by percutaneous transhepatic biliary external and internal drainage. Front. Med. China 1, 364–368 (2007). https://doi.org/10.1007/s11684-007-0070-y
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DOI: https://doi.org/10.1007/s11684-007-0070-y