梗阻性黄疸:流行病学、诊断和胆道减压最佳方法的选择

V. Darvin, P. S. Vetshev, S. V. Onishchenko, M. Lysak, T. Vardanyan, A. L. Kostrubin
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摘要

目的分析阻塞性黄疸的流行病学特征和发病率结构,估计这类患者的诊断和治疗结果,评估影响治疗和诊断方案有效性的因素。该研究基于四年来对 484 名机械性黄疸患者的治疗经验。超声波、CT、核磁共振成像、内窥镜超声波和胆道镜被用来诊断梗阻程度和梗阻性黄疸的原因。365名患者的主要减压方法是经胆道介入治疗。两名患者在内镜超声引导下接受了胆总管十二指肠造口术。82例患者采用了经皮经肝介入治疗和 "会合 "法。经毛细血管内镜逆行手术治疗梗阻性黄疸的有效率为93.4%。33名患者(8.4%)出现并发症,包括19名患者(4.9%)出现操作后胰腺炎,2名患者(0.5%)出现胰腺坏死,9名患者(2.3%)出现出血,2名患者(0.5%)出现十二指肠后穿孔,1名患者(0.3%)出现Mallory-Weiss综合征。前路经皮经肝介入治疗的有效率为95.1%,3.7%的患者出现肝实质出血。院内死亡率为0.8%(恶性肿瘤进展)。机械性黄疸患者在普通外科急诊中的比例越来越高,而且需要使用高科技设备进行诊断和治疗,因此有必要建立机械性黄疸患者治疗中心。针对特定适应症的逆行和顺行微创手术被认为是胆道减压的主要方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Obstructive jaundice: epidemiology, diagnosis and choice of optimal method of biliary decompression
Aim. To analyze epidemiological features and morbidity structure in obstructive jaundice, to estimate the results of diagnosis and treatment of this category of patients and to evaluate factors affecting the effectiveness of the treatment and diagnostic program.Materials and methods. The study was based on four-year experience of treatment of 484 patients with mechanical jaundice. Ultrasound, CT, MRI, endoscopic ultrasound, and cholangioscopy were used to diagnose the level of the obstruction and the causes of obstructive jaundice. The main method of decompression involved transpapillary interventions in 365 patients. Two patients underwent choledochoduodenostomy under endoscopic ultrasound guidance. Percutaneous transhepatic interventions and “rendezvous” method were applied in 82 cases.Results. The efficacy of transpapillary endoscopic retrograde procedures in obstructive jaundice accounted for 93.4%. Complications developed in 33 patients (8.4%) including postmanipulation pancreatitis – in 19 patients (4.9%), pancreatonecrosis – in 2 patients (0.5%), bleeding – in 9 patients (2.3%), retroduodenal perforation – in 2 patients (0.5%), Mallory–Weiss syndrome – in 1 patient (0.3%). The efficacy of antegrade percutaneous transhepatic interventions comprised 95.1%, while liver parenchyma bleeding developed in 3.7% of patients. In-hospital mortality amounted to 0.8% (malignant tumor progression).Conclusion. The increasing share of patients with mechanical jaundice in the structure of general surgical emergencies, as well as the need to use high-tech equipment for diagnosis and treatment, necessitate creating centers for treatment of patients with mechanical jaundice. Retrograde and antegrade minimally invasive surgeries for specific indications are considered to be the main methods of biliary decompression.
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