Patients with a mechanical jaundice, which is due to strictures of extrahepatic bile ducts of tumor genesis, during the first review of the doctor in 70-80% of cases are subject to palliative treatment. Decompression of bile ducts is the main direction to improve their state and increase life expectancy.
Many methods of decompression of bile ducts are proposed: antegrade and retrograde, with biliary drainage and stents, overlay of bili-dignistic anastomoses, but the choice of treatment method is still unspecified.
Each of the methods has its own disadvantages:
Percutaneous transhepatic biliary drainage (PTBD) dismisses a patient with a loss of a large number of bile, which should be used by рer os, and the presence of a lifeless port on the skin.
Endoscopic retrograde biliary stenting (ERBS) is accompanied by a trauma of the pancreas with the probability of pancreatitis, reflux of duodenal content in the biliary paths in 100% of patients, which leads to cholangitis and blockage of the stent, the stent dislocation.
Antegrade stenting limits the possibilities of stent sanation.
Bilio-digestive anastomoses are not always possible, especially with hilar strokes and carry risks inherent in surgical intervention.
Internal-external antengrad drainage involves the arrangement of drainage for a tumor into free bile ducts or duodenum, which provides natural evacuation of bile as such drainage has side openings above and below the tumor. At the same time, it is possible to leak the bile outside. Thoughts relative to the effectiveness of this approach are polar, because there was no differentiated analysis of its results depending on the location of the stricture and, accordingly, the distal end of drainage.
To solve issues regarding personalized choice of methodology of decompression of bile ducts (BD), there is a comprehensive comparative analysis, depending on the localization of stricture (high or low), but such studies have not yet been carried out.
The purpose of the work was to increase the effectiveness of palliative treatment of patients with organic stenosis of extrahepatic bile ducts with mechanical jaundice syndrome by justifying the choice of the method of mini-invasive interventions depending on the localization of stenosis and improvement of the method of internal-external biliary drainage.
The work had a number of tasks that provided for the determination of the most effective methods palliative treatment patients with a mechanical jaundice depending on the localization of stricture (proximal, distal). With proximal (high, hilar) strictures, there were relatively 4 techniques: PTBD, internal-external suprapapillary choledohostomy (IESCS), percutaneous transhepatic antegrade biliary stenting (PTABSt), ERBS (first stage of work); with distal (low) strictures, there were also comparatively 4 methods of PTBD, internal-external transpapillary choledohostomy (IETCS), ERBS and a methodology of internal-external biliary-ejunal drainage (IEBED) (a second stage of work) developed.
The points of the study were: clinical success of the procedure (decrease in the level of total serum bilirubin (TB) over 50% for 10 days after the procedure), the technical success of the procedure, the dynamics of reducing total TB and achieving control values of total TB 34.1 μmol / L (2 mg / dl) and 85 5 μmol / L (5 mg / dl) for which it is possible to use certain chemotherapy schemes, frequency and nature of complications of manipulation, cholangite frequency, index of cholangitis duration - ICD (number of days of cholangitis duration per 100 patient-days), the frequency of seeding of microflora and its character (in the presence of external drainage), cumulative survival, quality of life of patients with disease (MOS SF-36 scale).a radical operation.
Groups of patients (created in accordance with the methods of decompression of bile duct), which entered into the first and second stages, were statistically not differed in age, article, causes of mechanical jaundice, TNM tumor criteria, stage of process, concomitant diseases, medium values of total TB of blood serum, average term jaundice to treatment, all p> 0.05.
We found that in patients with mechanical jaundice all methods of decompression of biliary tract, both in the case of high, and in the case of low strictures, have statistically the same high clinical efficacy that ranges from 82% to 96.2%.
