Selection of decompression bile ducts in the treatment of patients with obstructive jaundice of tumor genesis

Abstract

The paper studied the analysis of results of treatment of 349 patients with obstructive jaundice on the background of the pancreatic head tumor, treated at the Clinical Hospital named after S.P. Botkin in the period from 2010 to 2015. A study group included 159 patients who had biliary tract decompression performed by retrograde endobiliary stenting. The comparison group was 167 patients who underwent percutaneous transhepatic cholangiostomy under ultrasound guidance and Rg control. In the treatment of patients with tumors of the head of the pancreas and the phenomena of jaundice secondary to severe-stage method of treatment used. The first step was performed decompression of the biliary tract, thus reducing the jaundice, to stop the phenomenon of cholangitis, liver failure and to prepare the patient for the second phase - surgery. Analysis of the results showed that within the first 5 days from the moment of decompression of the bile ducts were observed significant difference in reducing bilirubin levels in groups 1 and 2. However, in the next 10 days had significantly more rapid decline as total bilirubin and enzymes of cholestasis (alkaline phosphatase) in a retrograde decompression process. Bacteriological examination of infected bile decompression observed in both the methods, however microflora bile patients during decompression antegrade more numerous and includes microorganisms skin and the environment. In applying the method of retrograde decompression of the bile duct postoperative complications is less than the antegrade fashion. In patients with obstructive jaundice due to periampulary zone tumor should be favored in a retrograde fashion when choosing a method of decompression of the bile ducts. In the absence of technical possibility of its implementation - decompression of the bile duct should be implemented antegrade manner.