Krokidis Miltiadis, Hatzidakis Adam
Department of Radiology, Addenbrooke's University Hospital, Cambridge University Hospitals NHS Trust, Hills Road, P. O. Box 218, Cambridge, CB2 0QQ, UK,
Cardiovasc Intervent Radiol. 2014 Apr;37(2):316-23. doi: 10.1007/s00270-013-0693-0. Epub 2013 Jul 13.
The concept of percutaneous management of malignant biliary obstruction has not significantly changed in the last two decades and is based on the successful drainage of bile toward the duodenum, which normalizes liver function and prevents the development of cholangitis and sepsis. However, patient survival has changed slightly in the last two decades due to the advance of the diagnostic methods, chemo-radiotherapy protocols, and minimally invasive local control of the disease. Bare metal stents have not improved; however, newly developed covered biliary stents have been designed, and there is now evidence supporting their use in the clinical practice. However, other novel devices that may potentially offer benefit to patients with malignant biliary obstruction have been developed, such as drug-eluting biliary stents and intraductal ablation devices, and first feasibility trials have been published that offer encouraging results. These new technological developments, in combination with increased patient survival, bring new exciting data in this constantly developing area. The purpose of this review article is to investigate the latest published evidence on percutaneous minimal invasive palliation of malignant biliary disease and to delineate current trends.
在过去二十年中，经皮处理恶性胆管梗阻的概念并无显著变化，其基于胆汁成功引流至十二指肠，从而使肝功能正常化并预防胆管炎和脓毒症的发生。然而，由于诊断方法、放化疗方案以及疾病微创局部控制的进展，患者生存率在过去二十年中略有变化。裸金属支架并无改进；不过，新研发的覆膜胆管支架已设计出来，且目前有证据支持其在临床实践中的应用。然而，其他可能对恶性胆管梗阻患者有益的新型器械也已研发出来，如药物洗脱胆管支架和导管内消融装置，并且已发表的首批可行性试验给出了令人鼓舞的结果。这些新技术发展，再加上患者生存率的提高，为这个不断发展的领域带来了令人振奋的新数据。这篇综述文章的目的是研究关于经皮微创姑息治疗恶性胆管疾病的最新已发表证据，并勾勒当前趋势。
