Ell C
Medizinische Klinik II, Dr.-Horst-Schmidt-Kliniken, Wiesbaden.
Praxis (Bern 1994). 1998 Nov 11;87(46):1537-41.
Treatment of cholestasis by bile duct obstruction is nowadays dominated by endoscopy and other interventional measures. Intraductal concrements can be removed almost always without open surgery. This is as a rule achieved by a transpapillary approach with the additional use of lithothripsy. Percutaneous transhepatic treatment of concrements is restricted to patients in which a transpapillary approach is impossible. Stenoses of biliary ducts by malignancies are treated with plastic or metallic endoprosthesis if curative resection is precluded. Percutaneous drainage is a valid option in reserve. Stenosis of the papilla by scars, tumors or sphincter dysfunction are mainly treated endoscopically, malignancies--if possible--by radical surgery. Rare causes for obstruction have also to be considered. They are in most instances amenable to interventional procedures.
目前，胆管梗阻性胆汁淤积的治疗以内镜检查及其他介入措施为主。几乎总能在不进行开放手术的情况下清除导管内结石。通常通过经乳头途径并辅以碎石术来实现这一点。经皮经肝治疗结石仅限于无法采用经乳头途径的患者。如果无法进行根治性切除，恶性肿瘤导致的胆管狭窄则采用塑料或金属内支架治疗。经皮引流是备用的有效选择。瘢痕、肿瘤或括约肌功能障碍导致的乳头狭窄主要通过内镜治疗，恶性肿瘤——如果可能的话——则通过根治性手术治疗。还必须考虑罕见的梗阻原因。在大多数情况下，它们都适合采用介入治疗。
