恶性胆道梗阻的治疗对策  

Therapeutic strategy to malignant biliary obstruction

作　　者：孙晓梅[1] 唐秀芬[1] 孙凌宇[2] SUN Xiao-mei;TANG Xiu-fen;SUN Ling-yu(Heilongjiang Provincial Hospital, Harbin 150001, China;The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China)

机构地区：[1]黑龙江省医院,哈尔滨150001 [2]哈尔滨医科大学附属第四医院,哈尔滨150001

出　　处：《肿瘤代谢与营养电子杂志》2017年第1期11-16,共6页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：哈尔滨市应用技术研究与开发项目(2015RAXYL061)

摘　　要：MBO是由各种恶性肿瘤引起肝内和(或)肝外胆道狭窄或闭塞,导致梗阻性黄疸等全身症状的一类疾病。MBO患者多数伴有免疫功能低下和营养不良,解除胆道梗阻,合理进行肠内营养,是改善患者病情,以及接受其他治疗的基础。但是该病出现临床症状时,多数已失去根治性手术的机会,只能通过姑息性手术及胆汁引流术治疗。少数MBO患者可通过外科手术切除肿瘤、建立新的胆肠通路。对于大多数不能手术的患者,可采取胆汁引流解除梗阻。胆汁引流包括内引流和外引流,内引流是通过胆道支架置入,达到胆汁引流等目的;外引流是经皮肝穿刺胆汁引流术,是内引流失败后解除胆道梗阻的最佳选择。但是外引流胆汁大量丢失,严重影响患者消化功能和体液平衡。外引流的胆汁经鼻导管、空肠造瘘、PEG/J等通路回输到肠内,重建胆肠营养通路,具有重要的临床意义。MBO的营养管理分为肠内营养和静脉营养,术前存在营养障碍的手术患者应以中心静脉营养为主,尽快调整机体达到可以接受手术的营养状态,术后在肠道状态允许时,尽早开始肠内营养。对于非手术而行胆汁外引流的患者,尽可能采取胆汁回输联合肠内营养的方式进行营养管理。MBO was a class of diseases caused by a variety of malignant tumors in the liver and/or extrahepatic bile duct stenosis or occlusion,leading to obstructive jaundice and other systemic symptoms.The majority of patients with MBO were associated with poor immune function and malnutrition,removal of biliary obstruction,reasonable enteral nutrition,were to improve the patients'condition,as well as the basis for other treatment.However,most of the patients have lost the chance of radical operation,and could only be treated by palliative surgery and biliary drainage.A small number of patients with MBO could be surgically resected to establish a new approach to the biliary tract.For most patients who could not be operated,only biliary drainage could be used to relieve the obstruction.Bile drainage included internal and external drainage.Internal drainage achieved biliary drainage purposes through biliary stent implantation,however,external drainage achieved through percutaneous transhepatic biliary drainage which is the best choice after failure of biliary obstruction for internal drainage.Because the drainage would lead to loss of a large number of patients with serious influence on bile,digestive function and fluid balance,reinfusion of bile from external drainageby nasal catheter,jejunostomy,PEG/J pathway back into the intestine,and reconstruction of biliary enteric nutrition pathway haveimportant clinical significance.The nutritional management of MBO was divided into enteral nutrition and parenteral nutrition.Patients with preoperative nutritional disorders should be based on central venous nutrition,as soon as possible to adjust the body to achieve the nutritional status of surgery,and enteral nutrition should be started as soon as possible after the recovery of intestinal function.For patients with external drainage for bile,nutritional management should be carried out as much as possible in the way of bile reinfusion combined with enteral nutrition.

关 键 词：恶性胆道梗阻 营养通路 营养治疗 胆汁回输 

分 类 号：R730.5[医药卫生—肿瘤]