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梗阻性黄疸的病理生理后果及治疗策略

Pathophysiological consequences and treatment strategy of obstructive jaundice.

作者信息

Liu Jun-Jian, Sun Yi-Meng, Xu Yan, Mei Han-Wei, Guo Wu, Li Zhong-Lian

机构信息

Department of Hepatobiliary and Pancreatic Surgery, Tianjin Medical University Nankai Hospital, Tianjin 300102, China.

Graduate School, Tianjin Medical University, Tianjin 300070, China.

出版信息

World J Gastrointest Surg. 2023 Jul 27;15(7):1262-1276. doi: 10.4240/wjgs.v15.i7.1262.

Abstract

Obstructive jaundice (OJ) is a common problem in daily clinical practice. However, completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management. The effects of OJ are widespread, affecting the biliary tree, hepatic cells, liver function, and causing systemic complications. The lack of bile in the intestine, destruction of the intestinal mucosal barrier, and increased absorption of endotoxins can lead to endotoxemia, production of proinflammatory cytokines, and induce systemic inflammatory response syndrome, ultimately leading to multiple organ dysfunction syndrome. Proper management of OJ includes adequate water supply and electrolyte replacement, nutritional support, preventive antibiotics, pain relief, and itching relief. The surgical treatment of OJ depends on the cause, location, and severity of the obstruction. Biliary drainage, surgery, and endoscopic intervention are potential treatment options depending on the patient's condition. In addition to modern medical treatments, Traditional Chinese medicine may offer therapeutic benefits for OJ. A comprehensive search was conducted on PubMed for relevant articles published up to August 1970. This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.

摘要

梗阻性黄疸(OJ)是日常临床实践中的常见问题。然而,全面了解OJ的病理生理变化对于规划当前和未来的治疗仍具有挑战性。OJ的影响广泛,累及胆管树、肝细胞、肝功能,并引发全身并发症。肠道内胆汁缺乏、肠黏膜屏障破坏以及内毒素吸收增加可导致内毒素血症、促炎细胞因子产生,并诱发全身炎症反应综合征,最终导致多器官功能障碍综合征。OJ的恰当治疗包括充足的水分供应和电解质补充、营养支持、预防性使用抗生素、缓解疼痛和瘙痒。OJ的手术治疗取决于梗阻的原因、部位和严重程度。根据患者情况,胆管引流、手术和内镜干预是潜在的治疗选择。除了现代医学治疗外,中药可能对OJ有治疗作用。我们在PubMed上对截至1970年8月发表的相关文章进行了全面检索。本综述详细讨论了与OJ相关的病理生理变化,并提出了管理该病症的有效策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7cc/10405123/439f6e2a5b9b/WJGS-15-1262-g001.jpg

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