老年恶性梗阻性黄疸的减黄治疗进展及展望  

Progress and prospect of reducing jaundice tretment in elderly patients with malignant obstructive jaundice

作　　者：靳亚杰 孙海军[1] JIN Yajie;SUN Haijun(Department of General Surgery,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,P.R.China)

机构地区：[1]哈尔滨医科大学附属第一医院普外科,哈尔滨150001

出　　处：《中国普外基础与临床杂志》2021年第9期1249-1253,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结老年恶性梗阻性黄疸(malignant obstructive jaundice,MOJ)的各种减黄治疗方法,为老年MOJ的治疗提供参考意见。方法以"恶性梗阻性黄疸"为中文关键词,以"malignant obstructive jaundice"为英文关键词,计算机检索有关老年MOJ减黄治疗的文献并进行综述。结果老年MOJ的减黄治疗方法主要有根治性手术、胆管空肠吻合术、超声内镜引导下胆道引流术、内镜下胆道支架置入术、经皮经肝穿刺胆道引流及支架置入术等。根治性手术最有效,但对老年患者创伤大、并发症多;胆管空肠吻合术效果好,适用于不能耐受大手术的老年患者;超声内镜下胆道引流术对老年患者创伤小,但技术难度大;内镜下胆道支架置入术是目前老年MOJ晚期患者治疗的一线选择;经皮经肝穿刺胆道引流及支架置入术适用于年老体弱的高位梗阻患者。结论老年MOJ的治疗需要个体化和区域化,根据患者的病情和医疗中心的医疗水平选择合适的治疗方法。Objective To summarize the various treatment methods for reducing jaundice in the elderly patients with malignant obstructive jaundice(MOJ),and provide reference for the treatment of elderly MOJ.Method Using“malignant obstructive jaundice”as the Chinese keyword and the English keyword,a computer search of the literatures on the treatment of elderly MOJ patients was conducted and reviewed.Results The treatment methods of reducing jaundice in elderly MOJ included radical surgery,cholangiojejunostomy,endoscopic ultrasound-guided biliary drainage,endoscopic biliary stent implantation,percutaneous transhepatic biliary drainage and stent implantation.Radical surgery was the most effective,but it was traumatic and had many complications for elderly patients.Cholangiojejunostomy was effective and suitable for elderly patients who cannot tolerate major surgery.Endoscopic ultrasound-guided biliary drainage was less traumatic to elderly patients,but technical difficulty.Endoscopic biliary stent implantation was currently the first-line choice for the treatment of elderly patients with advanced MOJ.Percutaneous transhepatic biliary drainage and stent implantation were suitable for elderly and frail patients with high obstruction.Conclusion The treatment of elderly MOJ needs to be individualized and regionalized,and appropriate treatment methods should be selected according to the patient’s condition and the medical level of the medical center.

关 键 词：恶性梗阻性黄疸 经皮经肝穿刺胆道引流术 内镜下胆道支架置入术 老年患者 

分 类 号：R730.5[医药卫生—肿瘤]