Abstract
Aim. To show the optimal algorithm of diagnostic and treatment of malignant obstructive jaundice, which allows to increase the effectiveness of primary surgery, reducing the number of complications and mortality in the operated patients.Materials and methods. The results of examination and surgical treatment of 325 patients with malignant obstructive jaundice who underwent minimally invasive decompression of the biliary tract were studied. Based on the results of treatment, an algorithm for examining and treating patients with malignant obstructive jaundice has been formed and tested.Results. Using such criterial like severity of obstructive jaundice by E.I. Galperin, anatomical level of biliary tract occlusion and staging oncology process by TNM classification could help to choose the rational method for its surgical treatment and determine the risk of complications and mortality. At the level of biliary occlusion I and II, endoscopic stenting is a fairly successful inter-vention with a minimum of complications. For a level III block, the operation of choice is percutaneous transhepatic drainage. Cholecystostomy is advisable in case of level I block below the cystic duct in flow level and class “C” obstructive jaundice or for technical impossibility to apply a different method.Realization of the developed algorithm allowed resolving obstructive jaundice in a palliative option in 71.4% of patients and preparing 28.6% for surgical treatment.Conclusion. Implementation of an improved algorithm for the diagnosis of malignant obstructive jaundice makes it possible to justify the choice of a rational option for its surgical treatment, increase the effectiveness of interventions and reduce postoperative mortality.
Highlights
Цель: показать оптимальный алгоритм диагностики и лечения механической желтухи опухолевого генеза, позволяющий увеличить эффективность выбора первичного оперативного вмешательства, направленного на разрешение желчной гипертензии, уменьшение числа осложнений и летальности у оперируемых больных
Cholecystostomy is advisable in case of level I block below the cystic duct in flow level and class “C” obstructive jaundice or for technical impossibility to apply a different method.Realization of the developed algorithm allowed resolving obstructive jaundice in a palliative option in 71.4% of patients and preparing 28.6% for surgical treatment
Implementation of an improved algorithm for the diagnosis of malignant obstructive jaundice makes it possible to justify the choice of a rational option for its surgical treatment, increase the effectiveness of interventions and reduce postoperative mortality
Summary
The results of examination and surgical treatment of 325 patients with malignant obstructive jaundice who underwent minimally invasive decompression of the biliary tract were studied. Using such criterial like severity of obstructive jaundice by E.I. Galperin, anatomical level of biliary tract occlusion and staging oncology process by TNM classification could help to choose the rational method for its surgical treatment and determine the risk of complications and mortality. Анализ данных литературы свидетельствует о постепенном росте числа пациентов со злокачественными заболеваниями органов ГПДЗ. Среди пациентов с ЗНО органов ГПДЗ преобладают лица старшего и среднего возраста, которые имеют выраженные сопутствующие заболевания, а развивающаяся на этом фоне МЖ является угрожающим жизни осложнением. Особенностью течения ЗНО органов ГПДЗ является то, что даже при небольшом размере опухоли (до 2 см) имеется риск сосудистой инвазии, что ставит под сомнение успешность радикального оперативного лечения. МЖОГ, позволяющий увеличить эффективность выбора первичного оперативного вмешательства, направленного на разрешение желчной гипертензии, уменьшение числа осложнений и летальности у оперируемых больных
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More From: Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery
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