Деякі особливості ведення хворих із вогнищевими захворюваннями біліопанкреатодуодеальної зони, ускладненими механічною жовтяницею

Abstract

The aim of the current research was to compare the early results of pancreatoduodenal resection performing in patients with focal diseases of the biliopancreatoduodenal area complicated by obstructive jaundice syndrome, depending on the type of preoperative preparation. The results of surgical treatment of 272 patients who had been underwent pancreatoduodenal resection for focal diseases of the biliopancreatoduodenal zone complicated by the development of obstructive jaundice syndrome were analyzed. Patients, depending on the type of preoperative preparation, were randomized into two groups: the main group included 112 patients, who were prepared for surgery and predicted the course of the perioperative period in accordance with the original algorithm; and a comparison group (160 patients), in which the preparation was carried out only in a conservative way. Due to the original algorithm of detoxification with the use of biliary decompression in patients of the main group, the level of total bilirubin on the eve of pancreatoduodenal resection was 112.3 ± 2.7 μmol / L, while in the comparison group, where the preparation of patients for radical surgery was carried out without biliary drainage – 198.3 ± 3.3 μmol / L. The activity of alkaline phosphatase on the eve of PDR was 104.8 ± 1.3 U / L in the main group, and 270.8 ± 1.9 U / L in the comparison group (p <0.05). On the eve of PDR, the activity of γ-glutamyltransferase decreased insignificantly – to 529 ± 29 U / L in the comparison group and to 485 ± 33 U / L in the main group (p <0.05). The number of cases of life-threatening postoperative complications in the main group was 42 (37.5%), and in the comparison group – 102 (63.8%). Postoperative mortality in the main group was 6.3%, and in the comparison group – 11.9%.