Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, USA.
Dig Endosc. 2015 Jan;27(2):265-77. doi: 10.1111/den.12394. Epub 2014 Nov 17.
The role of preoperative biliary drainage (PBD) in patients with distal or proximal biliary obstruction secondary to resectable tumors has been a matter for debate. A review of the literature using Medline, Embase and Cochrane databases was undertaken for studies evaluating routes of drainage (endoscopic or percutaneous) and stent types (plastic or metal) in patients with resectable disease. Preoperative biliary drainage is indicated for relief of symptomatic jaundice, cholangitis, patients undergoing neoadjuvant therapy or those patients where surgery may be delayed. Endoscopic methods are preferred over percutaneous methods because of lower complication rates. In patients with proximal biliary obstruction, PBD should be guided by imaging studies to aid in selective biliary cannulation for unilateral drainage in order to reduce the risk of cholangitis in undrained liver segments.
术前胆道引流（PBD）在可切除肿瘤引起的远端或近端胆道梗阻患者中的作用一直存在争议。使用 Medline、Embase 和 Cochrane 数据库对评估可切除疾病患者引流途径（内镜或经皮）和支架类型（塑料或金属）的研究进行了文献回顾。术前胆道引流适用于缓解症状性黄疸、胆管炎、接受新辅助治疗或手术可能延迟的患者。由于并发症发生率较低，内镜方法优于经皮方法。对于近端胆道梗阻患者，PBD 应通过影像学检查进行指导，以帮助选择性胆道插管，实现单侧引流，从而降低未引流肝段发生胆管炎的风险。
