Lygidakis N J, Brummelkamp W H, Huibregtse K, Tytgat G N
Surg Gynecol Obstet. 1987 Feb;164(2):159-62.
This study assessed prospectively the results of endoscopic biliary drainage preoperatively in 40 patients with extrahepatic malignant biliary obstruction. The patients were divided into two groups depending upon the location of the obstruction. Those in group 1, n = 20, were patients with proximal malignant obstruction and those in group 2, n = 20, had distal malignant biliary obstruction. Preliminary endoscopic biliary drainage succeeded in lowering the biliary pressure and the incidence of bacteremia in patients in group 2. In contrast, for those in group 1, it failed to reduce the intrabiliary pressure and, thus, in the presence of bile infection led to an increased incidence of bacteremia. From the results of the present study, preliminary endoscopic biliary drainage is recommended for patients with distal malignant biliary obstruction. For those with proximal malignant biliary obstruction, surgical drainage appears to be the method of choice.
本研究前瞻性评估了40例肝外恶性胆管梗阻患者术前内镜下胆道引流的结果。根据梗阻部位将患者分为两组。第1组（n = 20）为近端恶性梗阻患者，第2组（n = 20）为远端恶性胆管梗阻患者。初步内镜下胆道引流成功降低了第2组患者的胆道压力和菌血症发生率。相比之下，对于第1组患者，它未能降低胆管内压力，因此，在存在胆汁感染的情况下导致菌血症发生率增加。根据本研究结果，推荐对远端恶性胆管梗阻患者进行初步内镜下胆道引流。对于近端恶性胆管梗阻患者，手术引流似乎是首选方法。
