Balogun Olanrewaju Samuel, Atoyebi Oluwole Ayoola
Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
J West Afr Coll Surg. 2022 Jul-Sep;12(3):111-119. doi: 10.4103/jwas.jwas_22_22. Epub 2022 Oct 6.
Malignant obstructive jaundice (MOJ) constitutes an important surgical problem with high morbidity and mortality worldwide. Presentation is usually delayed with a majority of patients benefitting only from palliative treatment. Surgeons practicing in developing countries face herculean task in managing MOJ due to lack of minimally invasive endoscopic procedures. Palliative surgical procedures are associated with high morbidity and sometimes mortality. Abdominal pain, generalized pruritus, and gastric outlet obstruction are some of the symptoms of MOJ requiring palliation. Successful surgical palliation may improve the overall quality of life in patients with MOJ considered fit for surgery. Bypass procedures and regional nerve blocks constitute the most effective surgical palliation available to surgeons practicing in resource-limited settings. This review article discusses the indications, the role, and types of surgical bypass procedures in the management of MOJ in contemporary surgical practice. This is important for surgeons in countries where expertise and resources for the less morbid endoscopic and radiologic approaches are not available. Relevant articles up to January 2021 published in PubMed, Google Scholar, and Hinari on the surgical management of obstructive jaundice were reviewed for inclusion. We also reviewed some modern surgical textbook topics on obstructive jaundice.
恶性梗阻性黄疸（MOJ）是一个重要的外科问题，在全球范围内具有较高的发病率和死亡率。其症状通常出现较晚，大多数患者仅能从姑息治疗中获益。由于缺乏微创内镜手术，发展中国家的外科医生在处理MOJ时面临艰巨任务。姑息性外科手术并发症发生率高，有时甚至会导致死亡。腹痛、全身瘙痒和胃出口梗阻是MOJ需要姑息治疗的部分症状。对于适合手术的MOJ患者，成功的手术姑息治疗可能会改善其整体生活质量。旁路手术和区域神经阻滞是资源有限地区外科医生可采用的最有效的手术姑息治疗方法。这篇综述文章讨论了当代外科实践中手术旁路手术在MOJ管理中的适应证、作用和类型。这对于那些无法获得低创伤性内镜和放射学治疗专业知识和资源的国家的外科医生来说很重要。我们检索了截至2021年1月发表在PubMed、谷歌学术和Hinari上有关梗阻性黄疸外科治疗的相关文章以纳入研究。我们还查阅了一些关于梗阻性黄疸的现代外科学教科书章节。
