Karimov Sh I, Akhmedov R M, Kim V L, Rasuleva M V, Perveĭs R
Khirurgiia (Mosk). 1991 Oct(10):30-5.
The authors analyse experience in the treatment of 132 patients with obstructive jaundice which was caused by a neoplastic lesion in 61 and by a benign disease in 71 of them. Bearing in mind the serious condition of this category of patients and the high risk of the operative intervention, two-stage treatment is applied with preliminary decompression of the biliary system and restoration of the main hepatic functions in the first stage. Transcutaneous endo-biliary interventions are carried out when other sparing methods cannot be accomplished or are ineffective. The authors give an integral, finer evaluation of the functional condition of the liver, elimination of the biliary microflora, and in this manner develop the criteria of the indications for the second stage of the intervention (prolonged bile passage in the intestine). In view of the high risk of the operative intervention, the authors suggest wider use of the methods of transcutaneous endo-biliary interventions according to indications. Nine patients died (6.8% mortality) in increasing hepatorenal insufficiency with growth of the oncological process.
作者分析了132例梗阻性黄疸患者的治疗经验，其中61例由肿瘤性病变引起，71例由良性疾病引起。考虑到这类患者的病情严重以及手术干预风险高，采用两阶段治疗，第一阶段对胆道系统进行初步减压并恢复主要肝功能。当其他保守方法无法实施或无效时，进行经皮内镜下胆道干预。作者对肝脏功能状况、胆道微生物清除情况进行了全面、细致的评估，并以此制定了干预第二阶段（胆汁在肠道内长期引流）的适应证标准。鉴于手术干预风险高，作者建议根据适应证更广泛地使用经皮内镜下胆道干预方法。随着肿瘤病情进展，9例患者死于进行性肝肾衰竭（死亡率6.8%）。
