摘要
临床上将恶性肿瘤直接侵及或压迫肝外胆道致胆汁排出受阻而引起的黄疽称为恶性梗阻性黄疸,根据阻塞部位一般可分为高位胆道梗阻和低位胆道梗阻。高位胆道梗阻多指高位胆管癌,即肝门部胆管癌。肝门部胆管癌手术相对复杂,术后死亡率高,而死亡原因多为肝衰竭。肝门部胆管癌的患者常常伴有黄疸,而重度的黄疸又会直接影响到体内多脏器的功能,因此许多学者提出了通过术前减黄的方法来降低围术期并发症发生的风险。但是目前对术前是否需要减黄仍存在较大争议,争议来源于减黄对改善患者预后是否有影响。本文结合国内外文献,就肝门部胆管癌术前减黄作一讨论。笔者认为,在一定的减黄指征下选择合适的减黄方式,减黄时间,将有益于改善患者的脏器功能,改善患者的预后。但目前还需要多中心合作的前瞻性研究来进一步确定减黄的金标准。
Clinically,the invasion and oncothlipsis of malignant tumors for the extrahepatic bile duct may cause obstruction of the bile,and we called it obstructive jaundice.According to the site of obstruction,we divided it into high bile duct obstruction and low bile duct obstruction.As we know,the high bile duct obstruction of malignant tumors is also known as hilar cholangiocarcinoma.The operation of hilar cholangiocarcinoma is complicated,and the postoperative mortality is high.Most patients with hilar cholangiocarcinoma manifest liver failure,which has been proved to be a significant risk factor affecting the surgical prognoses.Most patients of the hilar cholangiocarcinoma manifest jaundice,which may cause the organ damage.Many scholars proposed to reduce the incidence of complications by preoperative biliary drainage.But whether to perform a preoperative biliary drainage has always been a controversial topic.We plan to introduce the significance of the preoperative biliary drainage in this article.In my opinion,the appropriate indicators for operating the biliary drainage,the measure of biliary drainage,and operative opportunity after biliary drainage will be beneficial to the patient.However,large-scale multi-center clinical researches also need to establish the standards of preoperative biliary drainage.
作者
陈勇军
王达
CHEN Yong jun;WANG Da(Department of Biliary pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Chin)
出处
《医学与哲学（B）》
2018年第5期10-12,共3页
Medicine & Philosophy(B)
基金
2013年国家自然科学基金面上项目(81372239)
2015年国家自然科学基金面上项目(81572783)
关键词
高位胆管癌
黄疸
阻塞
术前减黄
hilar cholangiocarcinoma, jaundice, obstructive, preoperative biliary drainage
