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中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (02) : 157 -161. doi: 10.3877/cma.j.issn.2095-3232.2023.02.007

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肝门部胆管癌术前减黄及其对手术安全性的影响
单季军1, 李相成1,()   
  1. 1. 210029 南京医科大学第一附属医院肝胆中心
  • 收稿日期:2022-12-28 出版日期:2023-03-28
  • 通信作者: 李相成
  • 基金资助:
    江苏省科技厅社会发展面上项目(BE2020708)

Preoperative biliary drainage of hilar cholangiocarcinoma and its influence on safety of surgery

Jijun Shan1, Xiangcheng Li1()   

  • Received:2022-12-28 Published:2023-03-28
  • Corresponding author: Xiangcheng Li
引用本文:

单季军, 李相成. 肝门部胆管癌术前减黄及其对手术安全性的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 157-161.

Jijun Shan, Xiangcheng Li. Preoperative biliary drainage of hilar cholangiocarcinoma and its influence on safety of surgery[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(02): 157-161.

胆管癌是一组高度异质性的侵袭性癌症,可发生在胆道树内的任何地方。根据解剖位置可分为肝内胆管癌、肝门部胆管癌和远端胆管癌。肝门部胆管癌(hilar cholangiocarcinoma,HCCA)发生于肝总管、左右肝管及其汇合部,亦称高位胆管癌或Klatskin肿瘤,是胆管癌中最常见类型,约占所有胆管癌总数的60%[1]。HCCA患者因胆道梗阻引起一系列病理生理变化,临床表现为皮肤黄染、小便颜色加深、陶土样便、血清胆红素升高、肝酶异常等。高胆红素血症及肝功能异常会对手术安全性产生极大影响。胆道梗阻是HCCA的重要标志,评估胆道梗阻的程度,结合适当的胆道引流计划,是围手术期管理的重要组成部分。目前常用的术前减黄方式包括PTCD、内镜下胆道支架置入术(endoscopic biliary stenting,EBS)、内镜下鼻胆管引流术(ENBD)3种。笔者在本文对HCCA患者术前是否需要常规行减黄治疗,应该采取何种减黄方法及术前减黄对手术安全性的影响作一阐述。

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