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超声内镜引导下胆管引流在恶性胆管梗阻中的研究进展
蒋琪1,周玮1,邹多武2*,李兆申1
0
(1. 海军军医大学(第二军医大学)长海医院消化内科, 上海 200433;
2. 上海交通大学医学院附属瑞金医院消化内科, 上海 200025
*通信作者)
摘要:
恶性胆管梗阻(MBO)因胆汁排泄障碍引起梗阻性黄疸,可能导致胆管炎、脓毒血症、肝衰竭等并发症,甚至危及患者生命,胆管引流是解除症状、改善患者生活质量的有效手段。目前,对于无手术机会的MBO患者,经内镜逆行胰胆管造影(ERCP)置入金属支架是姑息性治疗的一线方法。近年来,对ERCP失败的MBO,超声内镜引导下胆管引流(EUS-BD)技术逐渐被接受,认为是优于经皮经肝穿刺胆管引流术(PTBD)的替代方法。有证据表明,由经验丰富的术者操作,对于远端MBO患者,EUS-BD甚至可以作为一线治疗方法替代ERCP。本文就EUS-BD在MBO中的研究进展进行综述。
关键词:  超声内镜  内镜逆行胰胆管造影术  胆管引流术  经皮经肝穿刺胆管引流术  恶性胆管梗阻
DOI:10.16781/j.0258-879x.2020.08.0880
投稿时间:2019-09-01修订日期:2020-03-31
基金项目:
Endoscopic ultrasound-guided biliary drainage in malignant biliary obstruction: research progress
JIANG Qi1,ZHOU Wei1,ZOU Duo-wu2*,LI Zhao-shen1
(1. Department of Gastroenterology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
*Corresponding author)
Abstract:
Malignant biliary obstruction (MBO) leads to obstructive jaundice as a result of bile excretion disorder, which may cause complications such as cholangitis, sepsis, hepatic failure and even life-threatening. Biliary drainage is an effective mean to relieve symptoms and improve patients' quality of life. At present, endoscopic retrograde cholangiopancreatography (ERCP) is the first-line palliative treatment for MBO patients without surgical opportunity. In recent years, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been gradually accepted as an alternative to percutaneous transhepatic biliary drainage (PTBD) in MBO with failed ERCP. The available evidence suggests that EUS-BD might even replace ERCP as the first-line procedure in patients with malignant distal biliary obstruction by experienced surgeons. This paper reviews the research progresses of EUS-BD in MBO.
Key words:  endoscopic ultrasound  endoscopic retrograde cholangiopancreatography  biliary drainage  percutaneous transhepatic biliary drainage  malignant biliary obstruction