2022 年第 12 期 第 17 卷

恶性胆道梗阻内镜下治疗方式的研究进展

Research progress on endoscopic treatment of malignant biliary obstruction

作者：何东1孙亦华1张文凯1庄乐怡1王祥2

英文作者：He Dong1 Sun Yihua1 Zhang Wenkai1 Zhuang Leyi1 Wang Xiang2

单位：1兰州大学第二临床医学院，兰州730030；2兰州大学第二医院消化内科，兰州730030

英文单位：1The Second Clinical Medical College Lanzhou University Lanzhou 730030 China; 2Department of Gastroenterology Lanzhou University Second Hospital Lanzhou 730030 China

关键词：恶性胆道梗阻；内镜胆道支架引流术；经皮肝穿刺胆道引流术；射频消融术；光动力疗法；内镜超声引导下胆管引流术

英文关键词：Malignantbiliaryobstruction;Endoscopicbiliarystentdrainage;Percutaneoustranshepaticbiliarydrainage;Radiofrequencyablation;Photodynamictherapy;Endoscopicultrasound-guidedbiliarydrainage

• 摘要：

• 恶性胆道梗阻是由胆道恶性肿瘤或转移癌导致的胆道梗阻性疾病引起，大部分患者在确诊时已丧失手术机会。当发生恶性胆道梗阻时，患者肝脏胆汁排泄障碍，导致梗阻性黄疸，在此基础上一旦合并胆管炎会导致患者肝功能衰竭和败血症，严重威胁患者生命。因此，临床医师常选择姑息性治疗以控制感染并缓解患者黄疸症状，进一步延长患者生存期、提高生存质量。目前，从解剖学角度来看，内镜下胆道引流是首选的姑息性治疗方案，但不同学者对于内镜下各种治疗方式的有效性及安全性仍存在争议。本文通过查阅相关文献，对恶性胆道梗阻患者的不同治疗方式进行综述，以期为临床医师选择有效的治疗策略提供依据。

• Malignant biliary obstruction(MBO) is a biliary obstructive disease caused by biliary malignancy or metastatic carcinoma, and most patients have lost the chance of surgery at the time of diagnosis. When MBO occurs, the function of patient′s liver in excreting bile disorder, leads to obstructive jaundice. On this basis, it will develop to liver failure and sepsis once patients combine with cholangitis, seriously threatening the patient′s life. Therefore, clinicians often choose palliative treatment to control the infection and relieve the jaundice symptoms, and further prolong the patient′s survival period and improve the quality of life. At present, in the antomic opinion, endoscopic biliary drainage as a palliative treatment option is preferred from the anatomical perspective. However, there are still controversy about the efficacy and safety of various endoscopic treatments among different scholars. This paper reviews the different treatment modalities of MBO patients by consulting the relevant literatures, in order to provide a basis for clinicians to choose effective treatment strategies.