梗阻性黄疸围手术期中西医研究进展

Research Progress of Traditional Chinese and Western Medicine Treatment for Obstructive Jaundice during Perioperative Period

梗阻性黄疸是日常临床实践中的常见问题,梗阻性黄疸的影响包括胆道系统,肝细胞和肝功能以及全身并发症。由于肠内胆汁不足,肠黏膜屏障功能被破坏,内毒素血症产生炎性细胞因子(TNF-α,IL-6)。胆红素会导致机体产生炎症反应综合征,进而造成多器官功能障碍。主要表现为血液动力学影响和急性肾功能衰竭、心血管抑制、免疫功能低下、凝血功能异常、营养受损和伤口愈合不良。临床上处理包括:补充水电解质平衡、维生素K、抗生素的应用、白蛋白和多巴胺、服用乳果糖、新鲜的冷冻血浆。总体研究上没有显示出术前胆道引流对患者更有利,而仅在少数病例中体现出其优势。所以对于黄疸患者,尤其是恶性肿瘤患者,围手术期管理就显得尤为重要。中医认为黄疸由于外感湿热邪毒,或饮食不洁,湿热内蕴而成劳,日久酿毒,正气耗损,湿热夹毒而难解,瘀阻血脉而导致。中药在利胆祛湿退黄方面发挥其优点,梗阻性黄疸患者围手术期适当的配合中医药治疗,更有助于患者的快速康复。完全了解梗阻性黄疸的病理生理变化和围手术期的处理仍然是未来治疗的挑战。

Obstructive jaundice is a common problem in daily clinical practice.The influences of obstructive jaundice include the biliary system,liver cells and liver functionand systemic complications.Due to intestinal bile deficiency,intestinal mucosal barrier destruction,increased endotoxin absorption and endotoxemia production of pro-inflammatory cytokines(TNF-α,IL-6),bilirubin can induce systemic inflammatory response syndrome,which may lead to multiple organ dysfunction.The main manifestations are hemodynamic effects and acute renal failure,cardiovascular suppression,immunodeficiency,abnormal coagulation function,nutritional impairment and poor wound healing.Clinical treatment includesadequate water and electrolyte supplementation,prophylactic antibiotics,lactulose,vitamin K and fresh frozen plasma,albumin and dopamine.The overall study dose not show that preoperative biliary drainage is more beneficial to patients,but only in a few cases shows its advantages.Therefore,for patients with jaundice,especially patients with malignant tumors,perioperative management is an important measure to improve the effect of appropriate surgery.Traditional Chinese medicine believes that jaundice is caused by exogenous damp-heat evil,or unclean diet,dampness-heat accumulation,long-term toxin,deficiency of vital Qi,damp-heat toxin and blood stasis.Traditional Chinese medicine has its unique advantages in cholestasis and jaundice.Appropriate perioperative treatment of obstructive jaundice with traditional Chinese medicine treatment is more conducive to the rapid recovery of patients.Fully understanding the pathophysiological changes of obstructive jaundice and the management of the perioperative period are still the challenges of future treatment.