对于远端和状胆道阻塞的手术前内镜胆道排水的现状
Hirotoshi Ishiwatari1, Junya Sato1, Hiroki Sakamoto1
1Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
概括
术前胆道排水 (PBD) 决策对于远端胆道和胆道胆道不同. 虽然PBD可以预防并发症,但其必要性取决于手术可行性和新辅助疗法持续时间.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 肝病学 肝病学是一种肝病学.
背景情况:
- 手术前胆道排水 (PBD) 旨在减轻外科手术后的并发症.
- 由于不同的手术程序和发病率,外肝胆道 (距离和) 需要单独考虑PBD.
研究的目的:
- 审查目前关于PBD对于远端和状胆道阻塞的必要性和方法的证据.
- 在新辅助疗法等不断发展的治疗模式的背景下,评估PBD的风险和益处.
主要方法:
- 随机对照试验的综述和最近关于PBD的临床观点.
- 不同排水技术的比较,包括金属与塑料支架以及内镜超声波导向排水.
- 对胰腺癌 (远端) 和状胆管癌 (状) 的PBD指示的分析.
主要成果:
- 对于偏远胆道阻塞 (例如胰腺癌),如果早期手术是可行的,由于胆道炎和胰腺炎的风险,PBD并不总是必要的.
- 新辅助疗法增加了对PBD在远端阻塞的需求,有利于金属支架较低的阻塞率.
- 对于状胆道阻塞 (例如,状胆道癌),越来越多地推PBD,特别是在主要肝切除术之前,以预防术后肝衰竭,内镜方法比穿皮方法更好.
结论:
- 对于远端和状胆道阻塞,PBD策略必须是个性化的.
- 虽然PBD可以有益,特别是对于需要主要肝切除术的状阻塞,但需要进行持续的研究来优化技术并最大限度地减少诸如胆管炎等并发症.
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