在胰腺癌的新辅助化疗期间胆道排水:证据和实际建议
Tadahisa Inoue1, Masanao Nakamura1, Kiyoaki Ito1
1Department of Gastroenterology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan.
Cancers
|February 13, 2026
概括
在患有阻塞性黄的胰腺癌患者进行不间断的新辅助化疗 (NAC) 时,术前胆道疏通至关重要. 策略旨在实现持久的支架通透性和最小的并发症,以确保及时治疗.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 干预性放射学 干预性放射学
背景情况:
- 胰腺癌通常是由于恶性胆道阻塞导致阻塞性黄的原因.
- 新辅助化疗 (NAC) 对可切除和边缘切除的胰腺癌至关重要.
- 胆道阻塞可以延迟或中断NAC,需要手术前胆道排水.
研究的目的:
- 对接受胰腺癌NAC治疗的患者,审查当前的胆管排水策略.
- 为了比较不同的排水方法关于穿透性,发病率和对外科手术的影响.
- 为手术前胆汁排水中临床决策提供指导.
主要方法:
- 在NAC期间对胆道排水技术的当前文献的综述.
- 通过皮膜排水 (用塑料支架的ERCP与SEMS) 和内镜超声波引导排水的比较.
- 讨论皮肤穿透肝胆道排水作为一种替代方案.
主要成果:
- 持久的内部排水是维持NAC时间表的关键.
- 苗条完全覆盖的SEMS在减少胰腺炎和胆囊炎等并发症方面表现有前途.
- 在某些特定情况下,内镜超声波导向排水可以作为救援或主要选择.
结论:
- 建议采用个性化,基于算法的胆管排水方法.
- 优先考虑持久的内部排水,以促进NAC.
- 皮穿式排水应保留在特定的适用情况;需要对长期结果进行进一步研究.
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