Rustagi Tarun, Jamidar Priya A
Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, PO Box 208019, New Haven, CT, 06520, USA,
Curr Gastroenterol Rep. 2015 Jan;17(1):426. doi: 10.1007/s11894-014-0426-9.
Endoscopic stenting is a widely accepted strategy for providing effective drainage in both extrahepatic and intrahepatic malignant strictures. In patients with extrahepatic malignancies, uncovered self-expanding metal stents (SEMS) provide excellent palliation. Hilar malignancies are probably best palliated by placement of uncovered SEMS although some disagreement exists among experts regarding the type and number of stents for optimal palliation. Preoperative biliary drainage (PBD) is commonly performed although a higher risk of complications and the lack of clear benefit raise questions about this practice. Certain groups of patients such as those with markedly elevated bilirubin levels, and in those in whom neoadjuvant therapy is planned, are good candidates for PBD. Considerable controversy exists regarding the optimal method as well as type of stent for PBD in patients with hilar malignancies. Novel endoscopic therapies, including photodynamic therapy and radiofrequency ablation, have emerged as potential adjuvant therapies in the management of malignant bile duct strictures but need further long-term evaluation to establish survival benefit. This review focuses on the current status of endoscopic therapies for malignant biliary obstructions.
内镜支架置入术是一种广泛接受的策略，用于对肝外和肝内恶性狭窄进行有效的引流。对于肝外恶性肿瘤患者，裸金属自膨式支架（SEMS）可提供良好的姑息治疗效果。肝门部恶性肿瘤患者可能通过置入裸金属自膨式支架实现最佳的姑息治疗，不过专家们对于实现最佳姑息治疗效果的支架类型和数量存在一些分歧。术前胆道引流（PBD）虽普遍应用，但并发症风险较高且缺乏明确益处，引发了对这种做法的质疑。某些患者群体，如胆红素水平显著升高的患者以及计划进行新辅助治疗的患者，是PBD的合适人选。对于肝门部恶性肿瘤患者的PBD，在最佳方法以及支架类型方面存在相当大的争议。新型内镜治疗方法，包括光动力疗法和射频消融，已成为恶性胆管狭窄治疗中的潜在辅助治疗手段，但需要进一步的长期评估以确定其对生存率的益处。本综述重点关注恶性胆道梗阻的内镜治疗现状。
