术前胆道引流在远端恶性胆道梗阻治疗中的研究进展

Advances in Preoperative Biliary Drainage in the Treatment of Distal Malignant Bile Duct Obstruction

胰头及壶腹部恶性肿瘤因具有特殊的解剖位置,常常压迫胆总管远端,以梗阻性黄疸为首要临床表现,引起血清胆红素水平升高、肝功能障碍、肾功能损害等并发症。术前胆道引流(Preoperative Biliary Drainage, PBD)广泛应用在恶性梗阻性黄疸的治疗中,用以解除胆道梗阻并降低总胆红素水平,被认为可能逆转肝功能障碍,提高患者手术耐受能力。目前临床上关于PBD的应用尚无指导性意见,其对胰十二指肠切除术后并发症及生存率的影响也存在争议。本文结合最新研究进展,讨论PBD在恶性梗阻性黄疸治疗中存在的相关问题,以期优化PBD临床实践方案,改善胰头癌、壶腹周围癌的综合治疗效果。

Due to the special anatomical location, pancreatic head and periampullary carcinoma often have obstructive jaundice as the first clinical manifestation caused by compression of the distal common bile duct, leading a series of complications such as increased bilirubin levels, impairment of liver and renal function. Preoperative biliary drainage (PBD) is widely used in the management of ma-lignant obstructive jaundice to relieve biliary obstruction, reduce serum bilirubin levels, and is thought to have the potential to reverse hepatic impairment and improve the patient’s ability to tolerate surgery. Currently, there is no guidance on the use of PBD in clinical work and the impact on post-pancreaticoduodenectomy complications and survival rates is controversial. This article discusses the problems associated with PBD in the treatment of malignant obstructive jaundice in the context of the latest international research advances, with a view to optimizing PBD practice protocols and improving the outcome of the comprehensive treatment of pancreatic head and per-iampullary carcinomas.