目的探讨过度引流在肝门胆管癌ERCP治疗前的作用。方法肝门胆管癌患者39例行内镜置管引流术,随机分为两组,研究组18例患者不造影鼻胆管过度引流(ENBD),4～7d后胆管造影放置塑料支架(ERBD)或金属支架(EMBE)。对照组21例常规逆行胰胆管造影(ERCP)并胆管引流。观察术后并发症和疗效。结果两组效果满意。研究组1例高热,未出现严重并发症。对照组死亡1例,转开腹1例。研究组术后并发症明显低于对照组。金属支架通畅期略长于塑料支架,但价格昂贵且并发症发生率高。结论肝门胆管癌内镜治疗可达到姑息减压、减黄的目的,但要慎重造影和置放金属支架。术前过度引流可预防和降低术后并发症。 Objective To investigate the role of overdrainage in the treatment of hilar cholangiocarcinoma before ERCP. Methods Thirty-nine patients with hilar cholangiocarcinoma underwent endoscopic catheter drainage and were randomly divided into two groups. Eighteen patients in study group did not have ENBD, and plastic stent (ERBD) was placed in 4 ~ 7 days after cholangiography Metal stent (EMBE). Control group, 21 cases of routine retrograde cholangiopancreatography (ERCP) and biliary drainage. Postoperative complications and efficacy were observed. Results two groups satisfied with the results. Study group 1 case of fever, no serious complications. One patient died in the control group and one patient turned to the laparotomy. The postoperative complications in the study group were significantly lower than those in the control group. Metal stents have a slightly longer patency than plastic stents, but are expensive and have a high complication rate. Conclusions The endoscopic treatment of hilar cholangiocarcinoma can achieve palliative decompression and yellow reduction, but radiography and metal stent placement should be carefully performed. Preoperative excessive drainage can prevent and reduce postoperative complications.