Wang Si-Zhen, Wang Xin-Bo
Hepatogastroenterology. 2013 Sep;60(126):1284-8. doi: 10.5754/hge13236.
BACKGROUND/AIMS: Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates. In obstructive jaundice, intestinal barrier dysfunction has been postulated to be a key factor contributing to high postoperative morbidity and mortality rates. Since surgery in patients with jaundice is thought to increase the risk of postoperative complications, preoperative biliary drainage (PBD) was introduced to improve the postoperative outcome. To date, whether biliary drainage should be routinely performed in patients with jaundice undergoing a pancreatoduodenectomy remains controversial, and the effect of biliary drainage on the intestinal barrier function in obstructive jaundice remains unknown.
Biliary drainage is almost exclusively associated with beneficial results, such as improved intestinal barrier function in experimental models. However, clinical data in this field are limited, indirect and remain controversial. Most importantly, routine PBD will result in a highly procedure-related complication rate and an increase in operative infectious complications.
PBD should not be performed routinely, unless further improved PBD techniques would become available in clinical studies. Future studies should focus on PBD techniques, and then on the effects of biliary drainage on intestinal mucosa in obstructive jaundice in clinical.
背景/目的：尽管术前评估和术后护理取得了进展，但用于缓解梗阻性黄疸的干预措施，尤其是手术，仍具有较高的发病率和死亡率。在梗阻性黄疸中，肠屏障功能障碍被认为是导致术后高发病率和死亡率的关键因素。由于黄疸患者的手术被认为会增加术后并发症的风险，因此引入了术前胆道引流（PBD）以改善术后结局。迄今为止，对于接受胰十二指肠切除术的黄疸患者是否应常规进行胆道引流仍存在争议，并且胆道引流对梗阻性黄疸患者肠屏障功能的影响尚不清楚。
在实验模型中，胆道引流几乎完全与有益结果相关，如改善肠屏障功能。然而，该领域的临床数据有限、间接且仍存在争议。最重要的是，常规PBD会导致与操作高度相关的并发症发生率以及手术感染性并发症增加。
除非在临床研究中能获得进一步改进的PBD技术，否则不应常规进行PBD。未来的研究应聚焦于PBD技术，然后关注临床中胆道引流对梗阻性黄疸患者肠黏膜的影响。
