肝门部胆管癌术前引流必要性及引流方式的探讨

The Necessity and Method of Preoperative Drainage for Hilar Cholangiocarcinoma

目前,外科手术是肝门部胆管癌的首选治疗方法。为了解除患者的梗阻性黄疸,改善肝功能,提高手术耐受性,术前引流被不断地用于患者术前管理,目前,术前引流的方式主要分为外引流和内引流。外引流以经皮经肝胆道穿刺引流(PTBD)为主;内引流包括内镜下鼻胆管引流(ENBD)、内镜下胆道支架植入(EBS),其安全性和有效性正不断被证实。但是,在引流方式的选择上,相关措施所能带来的实际疗效及操作风险,目前仍有争议。本文将结合国内外文献,从肝功能改善、提高根治性切除率、引流相关并发症的发生、临床及肿瘤学结局、诊断意义等方面,对肝门部胆管癌患者术前引流的必要性及引流方式的选择进行综述。

Surgery is currently the first choice for the treatment of hilar cholangiocarcinoma. In order to relieve obstructive jaundice, improve liver function, and improve surgical tolerance, preoperative drainage is continuously used for preoperative management of patients. The methods are mainly divided into external drainage and internal drainage. External drainage includes percutaneous transhepatic biliary puncture drainage (PTBD) and endoscopic nasobiliary drainage (ENBD). In terms of internal drainage, we mainly depend on endoscopic biliary stent implantation (EBS), whose safety and effectiveness are constantly being proven. However, there are still controversies on the choice of drainage methods, the actual curative effects and operative risks brought by the related treatment. Based on the fields of liver function improvement, radical resection improvement, occurrence of drainage-related complications, clinical and oncology outcomes and diagnostic significance, this article combines domestic and foreign literature to discuss the necessity of preoperative drainage and the choice of drainage methods.