The work is devoted to improvement surgical approaches to treating of the high level of obstructive jaundice of benign genesis.
The purpose of the work: Improving the results of treatment of patients with the high level of obstructive jaundice of benign genesis by optimizing the preparation of patients for surgery based on a comparative assessment of the functional status of the liver, the gastrointestinal tract and blood coagulation properties at various options of decompression of a biliary tract before radical surgery.
The structure of benign pathology leading to the high level of obstructive jaundice has been analyzed in the research. The study included the results of examination and treatment of 133 patients with this pathology. The results of using different approaches and methods of treatment of the high level of obstructive jaundice have been analyzed too.
Examination of patients with obstructive jaundice was based on physical, general clinical, radiological, endoscopic, mathematical, and statistical methods of the researches. The condition of patients was assessed based on clinical symptoms of the disease as well as laboratory and instrumental results of the research. The level of obstructive jaundice was determined in accordance with the Halperin classification system by 2014, considering the level of bilirubinemia.
Among the causes that had led to the development of the high level of obstructive jaundice in the vast majority of patients there were diagnosed with choledocholithiasis (53.3%). Strictures of the common bile ducts - (10.5%). Adenoma MDP was detected in 9% of the cases, indurative pancreatitis occurred in 8.2% of the cases. PCOS (choledocholithiasis) - in 11.2% of cases.
Patients were divided into three groups. The patients of the first group were conducted the external drainage of the biliary tract. Depending on the ways and the amount of bile inversion, it was divided into 4 subgroups. The patients of the First A (1 A) subgroup were performed the inversion of 100 % bile in the gastrointestinal tract orally, the patients of the First B (1 B) subgroup were performed the inversion of 50 % bile in the gastrointestinal tract orally, the patients of the First C (1 C) subgroup the inversion was not conducted at all and the patients of the First D
(1 D) subgroup 100% of bile was returned to the gastrointestinal tract through a nasogastric tube. The bile inversion was started from the third day after the biliary tract decompression.
The second group (II) consisted of the patients who had decompression of the biliary tract without their prior drainage by the performance of surgical interventions, during which biliodigestive anastomoses were formed.
The third group (III) consisted of patients who were treated according to our recommendations based on the results of the examination of groups I and II. Patients in all groups were comparable in their gender and age. Many of these patients – in the amount of 105 people (78.9%) - were elderly ones.
The dynamics of the functional state of the liver, absorption, and motor - evacuation function of the small intestine and the blood coagulation properties were monitored in accordance with the amount and methods of inversion of bile to the gastrointestinal tract. Evaluation of all studied indicators was performed on the 3,7,10 days after decompression of the biliary tract.
The clinical effectiveness of various methods of the bile duct decompression was studied. The condition of the gastric mucosa for oral bile conditions was re-searched.
As a result of the conducted researches it was concluded that the best dynamics of changes of laboratory parameters occurred in the patients after external drainage of the biliary tract, that had been returned 100% of bile to the gastrointestinal tract, regardless of the method of inversion.
In general, in groups I and II on the tenth day after the biliary tract decompression, most indicators of liver function were worse in the absence of the bile inversion to the gastrointestinal tract. This applies to the levels of total bilirubin, indirect bilirubin, transaminases, and only the levels of direct bilirubin and alkaline phosphatase did not show significant changes depending on the amount of bile inversion during the researches.
In the study of the function of the motor - evacuation and absorption functions of the gastrointestinal tract, a direct dependence on the amount of reversed bile was also revealed. The rates were the worst in the subgroup of patients who did not receive bile at all. This applies to the dynamics of changes in the level of D-xylose and fatty acids in the feces, as well as the activity of motor - evacuation function.
