不同解剖部位恶性梗阻性黄疸术前胆道引流的适应证与临床争议

Indications and clinical controversies of preoperative biliary drainage at different anatomical sites in malignant obstructive jaundice

摘要:

恶性梗阻性黄疸是由胆道梗阻引起、以高胆红素血症为主要特征的严重病理生理紊乱。为改善高胆红素血症对机体的不良影响并降低术后并发症发生风险，术前胆道引流（PBD）常作为围术期管理的重要策略。然而，PBD是否能够带来明确的临床获益仍存在较大争议。本综述系统梳理相关研究，重点探讨PBD在不同解剖部位胆道梗阻中的适应证、引流方式及临床价值，旨在为恶性梗阻性黄疸患者的外科治疗决策提供循证依据。

Abstract:

Malignant obstructive jaundice is a severe pathophysiological disorder characterized primarily by hyperbilirubinemia secondary to biliary obstruction. To mitigate the adverse effects of hyperbilirubinemia and reduce postoperative complications, preoperative biliary drainage (PBD) has long been employed as a perioperative management strategy. Nevertheless, whether PBD confers definitive clinical benefits remains a subject of considerable debate. This review systematically summarizes the current literature, with particular emphasis on the indications, approaches, and clinical value of PBD in relation to obstruction at different anatomical sites, aiming to provide evidence-based guidance for surgical decision-making in patients with malignant obstructive jaundice.