MODERN METHODS OF TREATING PATIENTS WITH DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

Abstract

Summary. Introduction. Treatment of patients with diseases of the biliary tract complicated by jaundice remains an urgent problem in abdominal surgery. The development of mechanical jaundice (MJ) is observed in 15–40 % of patients with gallstone disease complicated by choledocholithiasis. MJ of malignant etiology occurs in 40–67 % of patients.
 Aim. To study the results of the use of minimally invasive surgical interventions in patients with diseases of the biliary tract complicated by mechanical jaundice.
 Materials and methods. The object of the study were 56 patients with biliary tract complicated by MJ who were being treated in the State Institution “Zaycev V.T. Institute of general and emergency surgery of the National academy of medical sciences of Ukraine”. The first group included 34 patients with non-neoplastic diseases of the biliary tract, complicated by MJ, the second group included 22 patients with cholangiocarcinoma.
 Results. In subgroup 1A, 15 (41.1 %) patients underwent antegrade endobiliary interventions for the purpose of biliary decompression, in subgroup 1B 19 (55.9 %) patients had unsuccessful attempts at retrograde biliary decompression. The second stage of surgical treatment consisted of reconstructive and restorative operations or combined interventions from antegrade and retrograde approaches. Using antegrade endobiliary interventions, we managed to reduce the development of complications of biliary decompression, compared to patients who had an unsuccessful attempt at endoscopic treatment from 15 (78.9 %) to 1 (6.67 %), as well as reduce the number of complications after reconstructive and restorative operations from 10 (52.6 %) to 1 (6.67 %) and the fatality rate from 2 (10.5 %) to 1 (6.67 %).
 After successfully performed biliary decompression, 11 (50 %) patients underwent reconstructive and restorative surgical interventions, which were included in the 2A subgroup. The remaining 11 (50 %) patients, who made up the 2B subgroup, underwent similar surgical interventions without prior biliary decompression. In patients of the 2A subgroup, the performance of antegrade endobiliary intervention allowed to reduce the number of postoperative complications by 9.1 % and mortality by 9.1 % in comparison with the patients of the 2B subgroup.
 Conclusions. Thus, antegrade endobiliary interventions are an alternative method of treatment of diseases of the biliary tract complicated by MJ. Antegrade endobiliary interventions reduced the number of complications after reconstructive operations from 27.3 % to 18.2 %, the mortality rate from 18.2 % to 9.1 %. Antegrade endobiliary interventions for benign diseases of the biliary tract and improved minimally invasive methods of treatment of “endoscopic difficult” forms of choledocholithiasis reduced the number of complications of biliary decompression compared to patients in whom endoscopic decompression was ineffective from 78.9 % to 6.67 %, as well as reduced the level of postoperative complications after reconstructive treatment from 52.6 % to 6.67 % and mortality from 10.5 % to 6.67 %.