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| Therapeutic strategy to malignant biliary obstruction |
| 1SUN Xiao-mei, 1TANG Xiu-fen, 2SUN Ling-yu |
| 1SUN Xiao-mei, 1TANG Xiu-fen, 2SUN Ling-yu |
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Abstract MBO was a class of diseases caused by a variety of malignant tumors in the liver and/or extrahepatic bile duct stenosis or occlusion, leading to obstructive jaundice and other systemic symptoms. The majority of patients with MBO were associated with poor immune function and malnutrition, removal of biliary obstruction, reasonable enteral nutrition, were to improve the patients' condition, as well as the basis for other treatment. However, most of the patients have lost the chance of radical operation, and could only be treated by palliative surgery and biliary drainage. A small number of patients with MBO could be surgically resected to establish a new approach to the biliary tract. For most patients who could not be operated, only biliary drainage could be used to relieve the obstruction. Bile drainage included internal and external drainage. Internal drainage achieved biliary drainage purposes through biliary stent implantation, however, external drainage achieved through percutaneous transhepatic biliary drainage which is the best choice after failure of biliary obstruction for internal drainage. Because the drainage would lead to loss of a large number of patients with serious influence on bile, digestive function and fluid balance, reinfusion of bile from external drainage by nasal catheter, jejunostomy, PEG/J pathway back into the intestine, and reconstruction of biliary enteric nutrition pathway have important clinical significance.The nutritional management of MBO was divided into enteral nutrition and parenteral nutrition. Patients with preoperative nutritional disorders should be based on central venous nutrition, as soon as possible to adjust the body to achieve the nutritional status of surgery, and enteral nutrition should be started as soon as possible after the recovery of intestinal function. For patients with external drainage for bile, nutritional management should be carried out as much as possible in the way of bile reinfusion combined with enteral nutrition.
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