Gouma D J, Moody F G
Surg Gastroenterol. 1984;3(2):74-80.
The benefit of preoperative percutaneous transhepatic biliary drainage in patients with obstructive jaundice was reviewed in the literature from 1974 to July 1984. The role of preoperative drainage cannot be definitively assessed. Significant reduction of morbidity and mortality has been reported in some non-controlled studies; however, no benefit of preoperative "external" drainage was found in the only two reported randomized studies. At the present time external preoperative drainage cannot be advised routinely and the hazards of this technique and effect of bile losses may outweigh the benefits. The benefits of preoperative internal drainage without bile loss and closing of the enterohepatic cycle needs to be evaluated both percutaneously and endoscopically. Criteria, developed after specific identification of high risk patients, should be used to select patients for biliary drainage and to evaluate results of drainage studies. The clinical well-accepted drainage period of 2-4 weeks is controversial and the optimum period of drainage also requires further evaluation. The percutaneous approach carries significant morbidity and mortality.
对1974年至1984年7月期间的文献进行回顾，探讨了术前经皮经肝胆道引流对梗阻性黄疸患者的益处。术前引流的作用尚无法明确评估。一些非对照研究报告称发病率和死亡率显著降低；然而，在仅有的两项报道的随机研究中，未发现术前“外引流”有任何益处。目前，不建议常规进行术前外引流，该技术的风险及胆汁流失的影响可能超过其益处。术前无胆汁流失且闭合肠肝循环的内引流的益处，需要通过经皮和内镜两种方式进行评估。在明确高危患者后制定的标准，应用于选择进行胆道引流的患者并评估引流研究结果。临床上普遍接受的2至4周引流期存在争议，最佳引流期也需要进一步评估。经皮途径具有显著的发病率和死亡率。
