Современные подходы к лечению механической желтухи на фоне злокачественного поражения панкреатобилиарной зоны

Abstract

Aim. To study the role of tumors of the pancreatobiliary zone in the development of obstructive jaundice. To evaluate the effectiveness of endoscopic methods of diagnosis and treatment of this pathology. Materials and methods. The study is based on the results of the activities of JSC “MSU Neftyanik” in Tyumen for 2011-2020. During this period, 1284 patients with obstructive jaundice were admitted for emergency indications. Of this number, 181 patients had signs of cancerous lesions of the organs of the pancreatobiliary zone. The results obtained were used to evaluate effective endoscopic methods of diagnosis and treatment of patients in this group. Results. Malignant lesion of the pancreatobiliary zone is 14.3% of all cases of emergency treatment of patients with obstructive jaundice. The main cause is cancer of the pancreas, cancer of the bile ducts, as well as cancer of the large duodenal papilla and compression of the bile ducts “from the outside”. Performing emergency duodenoscopy on the first day after admission of patients made it possible to accurately verify the cancerous nature of the disease in the vast majority of patients. The most effective method for the relief of biliary hypertension syndrome in this group is bile duct stenting. Despite the varied nature of the cancer lesion, effective stenting was achieved in 71.3% of patients. If it is technically impossible to carry out stenting, minimally invasive puncture catheterization of the intrahepatic bile ducts is performed. Conclusion. Currently, cancer of the pancreatobiliary zone was established in every 5-7 patients with obstructive jaundice. Emergency duodenoscopy and ERCH is an effective diagnostic method that allows you to verify the “cancerous” nature of jaundice with a probability close to 100%. The most effective method of bile duct decompression in this group of patients is endoscopic transpapillary stenting.