Paik Woo Hyun, Loganathan Nerenthran, Hwang Jin-Hyeok
Woo Hyun Paik, Nerenthran Loganathan, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea.
World J Gastrointest Endosc. 2014 Mar 16;6(3):68-73. doi: 10.4253/wjge.v6.i3.68.
Hilar cholangiocarcinoma is a tumor of the extrahepatic bile duct involving the left main hepatic duct, the right main hepatic duct, or their confluence. Biliary drainage in hilar cholangiocarcinoma is sometimes clinically challenging because of complexities associated with the level of biliary obstruction. This may result in some adverse events, especially acute cholangitis. Hence the decision on the indication and methods of biliary drainage in patients with hilar cholangiocarcinoma should be carefully evaluated. This review focuses on the optimal method and duration of preoperative biliary drainage (PBD) in resectable hilar cholangiocarcinoma. Under certain special indications such as right lobectomy for Bismuth type IIIA or IV hilar cholangiocarcinoma, or preoperative portal vein embolization with chemoradiation therapy, PBD should be strongly recommended. Generally, selective biliary drainage is enough before surgery, however, in the cases of development of cholangitis after unilateral drainage or slow resolving hyperbilirubinemia, total biliary drainage may be considered. Although the optimal preoperative bilirubin level is still a matter of debate, the shortest possible duration of PBD is recommended. Endoscopic nasobiliary drainage seems to be the most appropriate method of PBD in terms of minimizing the risks of tract seeding and inflammatory reactions.
肝门部胆管癌是一种肝外胆管肿瘤，累及左肝主胆管、右肝主胆管或其汇合处。由于肝门部胆管癌的胆道梗阻水平复杂，其胆道引流有时在临床上具有挑战性。这可能会导致一些不良事件，尤其是急性胆管炎。因此，对于肝门部胆管癌患者的胆道引流指征和方法的决定应仔细评估。本综述重点关注可切除肝门部胆管癌术前胆道引流（PBD）的最佳方法和持续时间。在某些特殊指征下，如对Bismuth IIIA或IV型肝门部胆管癌进行右半肝切除术，或术前门静脉栓塞联合放化疗，强烈推荐进行PBD。一般来说，术前选择性胆道引流就足够了，然而，在单侧引流后发生胆管炎或高胆红素血症消退缓慢的情况下，可考虑进行全胆道引流。尽管最佳术前胆红素水平仍存在争议，但建议PBD的持续时间尽可能短。就将导管种植和炎症反应的风险降至最低而言，内镜鼻胆管引流似乎是PBD最合适的方法。
