Lai E C, Mok F P, Fan S T, Lo C M, Chu K M, Liu C L, Wong J
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Br J Surg. 1994 Aug;81(8):1195-8. doi: 10.1002/bjs.1800810839.
The role of preoperative endoscopic drainage for patients with malignant obstructive jaundice was evaluated in a randomized controlled trial. A total of 87 patients were assigned to either early elective surgery (44 patients) or endoscopic biliary drainage followed by exploration (43). Thirty-seven patients underwent successful stent insertion and 25 had effective biliary drainage. Complications related to endoscopy occurred in 12 patients. After endoscopic drainage significant reductions of hyperbilirubinaemia, indocyanine green retention and serum albumin concentration were observed. Patients with hilar lesions had a significantly higher incidence of cholangitis and failed endoscopic drainage after stent placement. The overall morbidity rate (18 patients versus 16) and mortality rate (six patients in each group) were similar in the two treatment arms irrespective of the level of biliary obstruction. Despite the improvement of liver function, routine application of endoscopic drainage had no demonstrable benefit. Endoscopic drainage is indicated only when early surgery is not feasible, especially for patients with distal obstruction.
在一项随机对照试验中评估了术前内镜引流对恶性梗阻性黄疸患者的作用。总共87例患者被分为早期择期手术组（44例患者）或内镜下胆管引流后再行探查组（43例）。37例患者成功置入支架，25例患者胆汁引流有效。12例患者发生了与内镜检查相关的并发症。内镜引流后，观察到高胆红素血症、吲哚菁绿潴留和血清白蛋白浓度显著降低。肝门部病变患者胆管炎发病率及支架置入后内镜引流失败率显著更高。无论胆管梗阻程度如何，两个治疗组的总体发病率（18例对16例）和死亡率（每组6例）相似。尽管肝功能有所改善，但内镜引流的常规应用并无明显益处。仅在早期手术不可行时才考虑内镜引流，尤其是对于远端梗阻患者。
