术前减黄在恶性低位梗阻性黄疸中的应用

姚丰; 游建

doi:10.14188/j.1671-8852.2025.0281

您当前的位置：

首页 >

文章列表页 >

术前减黄在恶性低位梗阻性黄疸中的应用

临床医学研究 | 更新时间：2026-11-05

- 术前减黄在恶性低位梗阻性黄疸中的应用
- Application of preoperative biliary drainage in malignant low obstructive jaundice
- 武汉大学学报（医学版） 2025年46卷第9期页码：1185-1189
- 作者机构：
  
  武汉市第四医院普外科湖北武汉 430033
- 作者简介：
  
  姚丰，男，1986—，医学硕士，主要从事肝胆胰相关疾病的研究，E⁃mail:yflq0914@163.com
  游建，男，1967—，教授，主任医师，主要从事肝胆胰相关疾病的研究，E⁃mail:jianyou67@163.com
- 基金信息：
- DOI：10.14188/j.1671-8852.2025.0281
  中图分类号： R730.56
- 收稿：2025-03-25，
  
  纸质出版：2025-09-26
- 稿件说明：
移动端阅览
姚丰,游建.术前减黄在恶性低位梗阻性黄疸中的应用[J].武汉大学学报（医学版）,2025,46(09):1185-1189.

YAO Feng,YOU Jian.Application of preoperative biliary drainage in malignant low obstructive jaundice[J].Medical Journal of Wuhan University,2025,46(09):1185-1189.
姚丰,游建.术前减黄在恶性低位梗阻性黄疸中的应用[J].武汉大学学报（医学版）,2025,46(09):1185-1189. DOI： 10.14188/j.1671-8852.2025.0281.

YAO Feng,YOU Jian.Application of preoperative biliary drainage in malignant low obstructive jaundice[J].Medical Journal of Wuhan University,2025,46(09):1185-1189. DOI： 10.14188/j.1671-8852.2025.0281.

摘要

目的

探讨不同术前减黄方式在恶性低位梗阻性黄疸中的减黄效果，并总结临床经验。

方法

本研究采用回顾性队列研究方法，收集2019年1月至2024年12月在同一中心接受术前减黄治疗，择期行胰十二指肠切除术的76例恶性低位梗阻性黄疸患者的临床资料。根据术前减黄方式将患者分为两组：内镜下逆行胰胆管造影（ERCP）支架植入组（

=41），接受内镜逆行胰胆管造影下胆道支架置入术；经皮肝胆管穿刺引流（PTCD）组（

=35），接受经皮经肝胆道穿刺引流术。比较两组患者的减黄效果，并对不同病理类型的患者进行亚组分析。

结果

经过减黄治疗后，ERCP组术前总胆红素（TB）低于PTCD组[74.9（37.6

135.4）μmol·L

-1

92.7（48.6

143.2）μmol·L

-1

，

0.05

]

，减黄有效率高于PTCD组（78.0%

60.0%，

0.05）。胆总管下段癌患者中，ERCP组术前TB低于PTCD组[68.6（33.9

127.3）μmol·L

-1

82.3（35.4

132.5）μmol·L

-1

，

0.05

]

，减黄有效率高于PTCD组（80.9%

61.1%，

0.05）。

结论

恶性低位梗阻性黄疸患者，尤其是胆总管下段癌患者，术前采用ERCP进行减黄治疗的临床效果优于PTCD，在临床实践中值得推荐。

Abstract

Objective

To investigate the jaundice⁃reducing outcomes of different preoperative biliary drainage methods in the treatment of malignant low obstructive jaundice

and to summarize the clinical experience.

Methods

A retrospective cohort study was conducted to collect the clinical data of 76 patients with malignant low obstructive jaundice who underwent preoperative jaundice⁃reducing treatment and elective pancreaticoduodenectomy in a single center from January 2019 to December 2024. The patients were divided into two groups according to the method of preoperative biliary drainage: ERCP group (

=41) underwent endoscopic retrograde cholangiopancreatography biliary stent placement

and PTCD group (

=35) underwent percutaneous transhepatic biliary drainage. The clinical outcomes of reducing jaundice was compared between the two groups

and subgroup analysis was performed according t

o their pathological types.

Results

After treatment

the serum total bilirubin (TB) in ERCP group was lower than that in PTCD group (74.9（37.6

135.4） μmol·L

-1

92.7（48.6

143.2） μmol·L

-1

0.05)

and the effective rate of relieving jaundice in ERCP group was higher than that in PTCD group (78.0%

60.0%

0.05). In patients with distal common bile duct cancer

the preoperative TB in the ERCP group was lower than that in the PTCD group (68.6（33.9

127.3） μmol·L

-1

82.3（35.4

132.5） μmol·L

-1

0.05)

and the effective rate of biliary drainage in the ERCP group was higher than that in the PTCD group (80.9%

61.1%

0.05).

Conclusion

For patients with malignant low obstructive jaundice

especially for those with distal common bile duct cancer

ERCP has a better clinical effect than PTCD for preoperative biliary drainage

and it is worth recommending in clinical practice.

关键词

Keywords

references

王冲 , 程石 . 可切除胰腺癌术前减黄的共识与争议 [J ] . 外科理论与实践 , 2022 , 27 ( 1 ): 30 ‑ 33 .

WANG C , CHENG S . Consensus and controversy: Preoperative biliary drainage for resectable pancreatic cancer [J ] . J Surg Concepts Pract , 2022 , 27 ( 1 ): 30 ‑ 33 .

SAYEED M S , EKAMBARAM G , RAJPUT J P S , et al . The impact of biliary drainage on quality of life in unresectable biliary and pancreatic cancer [J ] . Cureus , 2025 , 17 ( 2 ): e78986 .

PANG L W , WU S D , KONG J . Comparison of efficacy and safety between endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangial drainage for the treatment of malignant obstructive jaundice: A systematic review and meta‑analysis [J ] . Digestion , 2023 , 104 ( 2 ): 85 ‑ 96 .

王雷 , 张向化 , 伍路 , 等 . PTCD与ENBD对恶性梗阻性黄疸术前减黄效果的临床比较 [J ] . 肝胆胰外科杂志 , 2019 , 31 ( 5 ): 310 ‑ 313 .

WANG L , ZHANG X H , WU L , et al . Comparation of PTCD and ENBD for preoperative jaundice reduction in malignant obstructive jaundice patients [J ] . J Hepatopancreatobiliary Surg , 2019 , 31 ( 5 ): 310 ‑ 313 .

WANG Y Z , ZHAO X B , SHE Y , et al . The clinical efficacy and safety of different biliary drainage in malignant obstructive jaundice: A meta‑analysis [J ] . Front Oncol , 2024 , 14 : 1370383 .

CAI Y H , FAN Z Y , YANG G W , et al . Analysis of the efficacy of percutaneous transhepatic cholangiography drainage (PTCD) and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of malignant obstructive jaundice (MOJ) in palliative drainage and preoperative biliary drainage: A single‑center retrospective study [J ] . BMC Surg , 2024 , 24 ( 1 ): 307 .

PÁEZ‑CARPIO A , HESSHEIMER A , BERMÚDEZ P , et al . Percutaneous transhepatic biliary drainage for biliary obstruction in perihilar cholangiocarcinoma: A 10‑year analysis of safety and outcomes using the CCI index [J ] . Langenbecks Arch Surg , 2023 , 408 ( 1 ): 109 .

BIAN C , FANG Y , XIA J , et al . Is percutaneous drainage better than endoscopic drainage in the management of patients with malignant obstructive jaundice? A meta‑analysis of RCTs [J ] . Front Oncol , 2023 , 13 : 1105728 .

李宗倍 , 王刚 . 恶性梗阻性黄疸诊治现状 [J ] . 肝胆胰外科杂志 , 2025 , 37 ( 1 ): 61 ‑ 67 .

LI Z B , WANG G . Current status of diagnosis and treatment of malignant obstructive jaundice [J ] . J Hepatopancreatobiliary Surg , 2025 , 37 ( 1 ): 61 ‑ 67 .

MATSUMI A , KATO H , UEKI T , et al . Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: A retrospective multicenter study [J ] . BMC Gastroenterol , 2021 , 21 ( 1 ): 28 .

LANGERTH A , ISAKSSON B , KARLSON B M , et al . ERCP‑related perforations: A population‑based study of incidence, mortality, and risk factors [J ] . Surg Endosc , 2020 , 34 ( 5 ): 1939 ‑ 1947 .

谭中宝 , 毛学群 , 张建 , 等 . 恶性梗阻性黄疸经皮肝穿刺胆道外引流与内外引流对照研究 [J ] . 实用放射学杂志 , 2023 , 39 ( 7 ): 1166 ⁃ 1169 .

TAN Z B , MAO X Q , ZHANG J , et al . A comparative study on percutaneous transhepatic biliary external drainage and internal and external drainage in malignant obstructive jaundice [J ] . Journal of Practical Radiology , 2023 , 39 ( 7 ): 1166 ⁃ 1169 .

中华人民共和国国家卫生健康委员会医政医管局 , 赵玉沛 , 王成锋 . 胰腺癌诊疗指南(2022年版) [J ] . 中华消化外科杂志 , 2022 , 21 ( 9 ): 1117 ‑ 1136 .

Medical Administration Bureau of the National Health Commission of PRC , ZHAO Y P , WANG C F . Standardization for diagnosis and treatment of pancreatic cancer(2022 edition) [J ] . Chin J Dig Surg , 2022 , 21 ( 9 ): 1117 ‑ 1136 .

WU H T , XIE X . Efficacy and influencing factors of percutaneous transhepatic cholangiography and biliary drainage in malignant obstructive jaundice patients [J ] . Am J Transl Res , 2024 , 16 ( 12 ): 7725 ‑ 7733 .

杨林华 , 刘颖斌 . 胆道肿瘤外科治疗的争议和共识 [J ] . 临床外科杂志 , 2022 , 30 ( 11 ): 1001 ‑ 1004 .

YANG L H , LIU Y B . Controversy and consensus on surgical treatment of biliary tract tumors [J ] . J Clin Surg , 2022 , 30 ( 11 ): 1001 ‑ 1004 .

EL‑HADDAD H M , SABRY A A , SHEHATA G M . Endoscopic versus percutaneous biliary drainage for resectable pancreatic head cancer with hyperbilirubinemia and impact on pancreaticoduodenectomy: A randomized controlled study [J ] . Int J Surg , 2021 , 93 : 106043 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

抑制Kupffer细胞功能对梗阻性黄疸大鼠肝功能的保护作用及其机制

小檗碱对梗阻性黄疸大鼠肝细胞线粒体能量代谢的保护作用

铃蟾肽对梗阻性黄疸肠道的保护作用

艾灸联合光疗在糖尿病足患者中的应用效果

预防性镇痛联合阶梯式干预对学龄期急性阑尾炎患儿疼痛控制的影响