恶性梗阻性黄疸术前减黄相关问题及争议的探讨  

The Problems and Discussion on the Controversy of Preoperative Biliary Drainage in Malignant Obstructive Jaundice

作　　者：姜岚[1] 孟兴凯[1] 

机构地区：[1]内蒙古医科大学第一附属医院普外科,呼和浩特010059

出　　处：《医学综述》2014年第5期806-809,共4页Medical Recapitulate

摘　　要：恶性梗阻性黄疸是因壶腹周围肿瘤、胰头或肝门胆管肿瘤侵犯、压迫肝外胆管导致胆管内压增高,胆汁排出受阻,进而使胆红素逆流入血,引起的以皮肤巩膜黄染、尿色加重以及陶土样大便为主要临床表现的一类疾病。它会引起机体多个脏器及系统功能损伤,因此对于术前减黄是否有利于患者预后的问题存在着不少争议,由于缺少有说服力的随机数据,临床指导的发展受到限制,因而也导致了治疗上的不统一性。随着研究的深入,术前减黄的观念已发生了改变,而针对术前减黄,减黄的时机、减黄的方式及部位、减黄的程度以及对应的手术时机即成为争议的焦点。Malignant obstructive jaundice is a series of disease due to periampullary maglignancy, the head of pancreas or porta hepatis bile duct carcinoma invasion or oppression on extrahepatic biliary tract that leads to higher internal pressure and biliary bile outflow blockage, causing the bilirabin reflux into the blood- stream,with resulted yeliow skin and sclera, aggravating color of urine and the clay-like stool as the main clinical manifestations. Patients with obstructive jaundice have various pathophysi01ogical changes that affect many organs and systems. There is considerable controversy as to whether temporary relief of biliary obstruc- tion prior to major definitive surgery （ pre-operative biliary drainage ） is of any benefit to the patient. The development of clinical guidelines has been limited by lacking of convincing randomized data, which in turn has led to variations in treatment option. The view of preoperative biliary drainage has changed dramatically, as for the preoperative biliary drainage, the timing, reduction way and position, and reduction degree and corresponding operation time have become the focuses of the controversy.

关 键 词：恶性梗阻性黄疸 术前减黄 减黄争议 

分 类 号：R657.43[医药卫生—外科学]