RECONSTRUCTIVE SURGERY IN PATIENTS WITH MALIGNANT DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

Abstract

The causes of mechanical jaundice (MJ) are benign and malignant diseases of the hepaticopancreaticoduodenal area. Literature sources indicate the development of MJ in 15-40 % of patients with gallstone disease and in the vast majority of patients with malignant neoplasms of the biliary tract. MJ of malignant etiology occurs in 40-67 % of patients.
 Aim. To study the results of the use of reconstructive surgery in patients with malignant diseases of the biliary tract complicated by mechanical jaundice.
 Materials and methods. An analysis of surgical treatment of 22 patients with malignant diseases of the biliary tract complicated by MJ in the SI “ V.T. Zatsev IGUS NAMSU ». Patients are divided into subgroups. Subgroup 1 - 11 (50 %) included patients treated with antegrade endobiliary interventions as biliary decompression. Subsequently, the reconstructive and restorative stage of surgical treatment was performed. Subgroup 2 - 11 (50 %) included patients who underwent reconstructive surgery without prior biliary decompression.
 Results of the research. After successful biliary decompression, 11 (50 %) patients underwent reconstructive surgery, which was included in 1 subgroup. The remaining 11 (50 %) patients in subgroup 2 underwent similar surgery without prior biliary decompression. In patients of subgroup 1 (n = 11 (50 %)) we performed percutaneous transhepatic cholangiodrainage for biliary decompression and MJ resolution. After its successful implementation, the reconstructive and restorative stage of surgical treatment was performed. This reduced the number of postoperative complications from 18.2 % to 9.1 % compared with subgroup 2 of patients who underwent surgery without prior biliary decompression.
 Conclusions. Performing reconstructive and reconstructive operations in conditions of high levels of serum bilirubin, cholangitis, hepatic failure is dangerous and is accompanied by a large number of complications in the postoperative period. In patients who underwent antegrade endobiliary interventions as a previous biliary decompression, complications were noted in 2 (18.2 %) cases and mortality was 9.1 % (1 patient), which reduced the number of postoperative complications by 9.1 % and mortality by 9.1 %. This is confirmed by studies that prove the benefits of antegrade endobiliary interventions in the preparation of patients for reconstructive surgery in comparison with their performance without the use of the latter.