Megison S M, Dunn C W, Horton J W, Chao H
Department of Surgery, University of Texas Southwestern Medical Center, Dallas.
Br J Surg. 1991 May;78(5):568-71. doi: 10.1002/bjs.1800780516.
Obstructive jaundice causes depression of immune system function but it is unclear at present how rapidly immune function recovers after relief of biliary obstruction. To address this issue, we studied 218 Sprague-Dawley rats with common bile duct obstruction. Mononuclear phagocyte function, cell mediated immune function, portal-systemic shunt fraction, liver function tests, and liver histology were evaluated in normal (sham) rats, obstructed rats, and at weekly intervals after relief of biliary obstruction. Hepatic uptake of radiolabelled bacteria was 82 per cent in sham rats and 66 per cent in rats 21 days after CBD obstruction (P less than 0.05). Phagocytic activity returned to normal within 7 days after choledochoduodenostomy. Cell mediated immunity, measured by skin graft rejection, was significantly prolonged in the obstructed group (P less than 0.05) but had returned to normal 7 days after biliary diversion. Return of hepatocellular function, as measured by liver function tests, paralleled recovery of immune function. This study demonstrates prompt recovery of the immune system after internal biliary drainage for obstructive jaundice. This finding is in contrast to previous studies that demonstrated persistent immune suppression months after biliary diversion. These data may have implications concerning the usefulness of internal biliary drainage before surgery in patients with obstructive jaundice.
梗阻性黄疸会导致免疫系统功能抑制，但目前尚不清楚胆管梗阻解除后免疫功能恢复的速度有多快。为了解决这个问题，我们研究了218只胆总管梗阻的Sprague-Dawley大鼠。对正常（假手术）大鼠、梗阻大鼠以及胆管梗阻解除后的每周进行单核吞噬细胞功能、细胞介导的免疫功能、门体分流分数、肝功能检查和肝脏组织学评估。假手术大鼠肝脏对放射性标记细菌的摄取率为82%，胆总管梗阻21天后的大鼠为66%（P<0.05）。胆总管十二指肠吻合术后7天内吞噬活性恢复正常。通过皮肤移植排斥反应测量的细胞介导免疫在梗阻组显著延长（P<0.05），但在胆管改道7天后恢复正常。通过肝功能检查测量的肝细胞功能恢复与免疫功能恢复平行。本研究表明梗阻性黄疸行内胆管引流术后免疫系统迅速恢复。这一发现与先前的研究相反，先前的研究表明胆管改道数月后仍存在持续的免疫抑制。这些数据可能对梗阻性黄疸患者术前内胆管引流的有效性具有启示意义。
