Медицинская литература. Новинки

 

 

 

 

 

 

Эндоскопические методы диагностики и лечения проксимальной билиарной обтурации опухолевого генеза (обзор литературы)

Проксимальная билиарная обтурация происходит при опухоли Клацкина, внутрипеченочной холангиокарциноме, раке желчного пузыря или метастатическом поражении ворот печени и сопровождается плохим прогнозом. Совершенствование эндоскопических технологий осуществляют в направлении более точной диагностики и более безопасного дренирования. Транспапиллярную щеточную и щипцовую биопсию широко применяют для морфологической диагностики. Развиваются такие методы диагностики, как пероральная холангиоскопия и конфокальная лазерная эндомикроскопия. Разработка различных инструментов и прогресс в таких технологиях, как ЭРХПГ и эндо-УЗИ, позволили увеличить частоту технически и клинически успешных процедур при высоком билиарном блоке. Тем не менее обсуждение параметров стентов, места локорегионарной паллиативной терапии и некоторых других аспектов все еще продолжается. В обзоре литературы представлены сведения об оптимальных эндоскопических методах диагностики и лечения, применяемых при проксимальной злокачественной билиарной обтурации, полученные в результате анализа последних научных публикаций.

Ключевые слова:
желчные протоки, опухоль Клацкина, холангиокарцинома, проксимальная билиарная обтурация, эндоскопические технологии, стентирование, внутрипротоковая биопсия, bile ducts, Klatskin tumor, cholangiocarcinoma, proximal biliary obstruction, endoscopic technologies, stenting, intraductal biopsy

Литература:
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Endoscopic diagnosis and treatment for proximal biliary obstruction of tumor origin (literature review)

Proximal biliary obstruction occurs in Klatskin tumor, intrahepatic cholangiocarcinoma, gallbladder cancer or metastatic lesion of the portal fissure and implies poor prognosis. Endoscopic techniques have been advanced towards more accurate diagnosis and safer drainage. Transpapillary brush and forceps biopsy are widely used for morphologic diagnosis. Development of diagnostic techniques includes peroral cholangioscopy and confocal laser endomicroscopy. Due to the development of various tools and advances in ERCP and EUS technologies, a number of technically and clinically successful procedures for high biliary obstruction is increasing. Nevertheless, stent parameters, potential of locoregional palliative care and some other aspects remain disputable. The literature review presents best practices of endoscopic diagnosis and treatment for proximal malignant biliary obstruction, obtained from the analysis of recent scientific publications.

Keywords:
желчные протоки, опухоль Клацкина, холангиокарцинома, проксимальная билиарная обтурация, эндоскопические технологии, стентирование, внутрипротоковая биопсия, bile ducts, Klatskin tumor, cholangiocarcinoma, proximal biliary obstruction, endoscopic technologies, stenting, intraductal biopsy