Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
HPB (Oxford). 2007;9(6):408-13. doi: 10.1080/13651820701729986.
Following the introduction of percutaneous and endoscopic biliary drainage there has been an ongoing debate about the indications and outcomes of endoscopic versus surgical drainage in a variety of bilio-pancreatic disorders. The evidence-based literature concerning four different areas of pancreatobiliary diseases have been reviewed. Preoperative endoscopic biliary drainage in patients with obstructive jaundice should not be used routinely but only in selected patients. For patients with biliary leakage and bile duct strictures after a laparoscopic cholecystectomy, endoscopic stent therapy might be first choice and surgery should be used for failures of endoscopic treatment. Surgery is the treatment of choice after transection of the bile duct (the major bile duct injuries). The majority of patients with obstructive jaundice due to advanced pancreatic cancer will undergo endoscopic drainage but for relatively fit patients with a prognosis of more than 6 months, surgical drainage or even palliative resection might be considered. For patients with persistent pain due to chronic pancreatitis surgical drainage combined with limited pancreatic head resection might be first choice for pain relief. Most importantly, the management of patients with these pancreatobiliary diseases should be performed by a multidisciplinary HPB approach and teamwork consisting of gastroenterologists, radiologists and surgeons.
经皮和内镜胆道引流术的引入引发了一场持续的争论，即内镜与手术引流在各种胆胰疾病中的适应证和结果。对有关四种不同胰胆疾病领域的循证文献进行了回顾。术前梗阻性黄疸患者不应常规行内镜胆道引流，仅在选择的患者中使用。对于腹腔镜胆囊切除术后发生胆漏和胆管狭窄的患者，内镜支架治疗可能是首选，对于内镜治疗失败的患者应采用手术治疗。对于胆管横断（主要胆管损伤）的患者，手术是治疗的首选。大多数因晚期胰腺癌引起的梗阻性黄疸患者将接受内镜引流，但对于预计生存期超过 6 个月的相对健康的患者，可能会考虑手术引流甚至姑息性切除。对于因慢性胰腺炎持续疼痛的患者，手术引流结合有限的胰头切除术可能是缓解疼痛的首选。最重要的是，这些胰胆疾病患者的管理应由多学科肝胆管病学方法和由胃肠病学家、放射科医生和外科医生组成的团队来完成。
