The dissertation deals with the research of preoperative biliary decompression (PBD) impact in patients with malignant obstructive jaundice (MOJ) complicated by
cholangitis at the course of the disease, the development of postoperative (PO) complications, effictiveness and prognosis of the treatment.
The basis of the research is the analysis of the clinical material of the results of the treatment of 136 patients with MOJ, who were hospitalized in Kyiv City Department of surgical treatment of the liver, the pancreas and the bile tract diseases named after
V.S. Zemskov based at the Municipal non-financial establishment «Kyiv City Clinical Hospital №10» which is the clinical site for the Department of General Surgery №1 of Bogomolets National Medical University for the period from 2016-2022.
While performing the scientifiс research, general clinical, laboratory, instrumental, morphological, bacteriological and statistical methods were used.
Inclusion criteria in the study were: MOJ (localization – pancreas, duodenum, papilla Fateri, ductus choledochus, morphological verification of the primary tumor, primary tumor resectability, age of patients older 18 years old, patient consent to participate in the study and further outpatient monitoring.
Non-inclusion criteria: performance of any invasive interventions on the biliary tree due to the underlying disease before hospital admission; the functional patient state estimated at 4-5 points on the ECOG scale; class V-VI of ASA classification operative risk; IV clinical group of oncological patients; the presence of acute surgical pathology unrelated to the main disease; decompensated comorbid pathology; diagnosed viral hepatitis at the time of hospitalization; autoimmune liver diseases; ascites; complications directly related to the performance of biliary decompression.
Exclusion criteria: refusal of the patient from diagnosis and treatment at any stage of the study; death of the patient not related to the underlying disease.
At the first stage, a retrospective-prospective analysis of the treatment results of 136 patients with MOJ was performed. All patients, included in the conducted study, were divided into two groups, which were comparable in nosology and volume of surgical intervention, they differed only according to presence or absence of previous biliary decompression. The group A included 84 patients who underwent PBD, among them – endobiliary stenting (EBS) was performed to 56 (66,7 %) patients, percutaneous transhepatic biliary drainage (PTBD) was performed to 28 (33,3 %); PBD was't done to 52 patients of group B. The presence of comorbidity was identified in 69 patients (50,7 %). Preoperative ascending cholangitis (PAC) was diagnosed in all patients of group A, among them: 48 patients (57,1 %) had I degree of severity, 36 patients (42,9 %) had II degree of severity; in group B cholangitis of I degree was found in 21 patients (40,4 %), the rest 31 patients (59,6 %) had only cholestasis, which did not statistically distinguish two groups of patients with cholangitis I degree, p=0,09; the difference was determined as cholangitis of II degree, p=0,001 and cholestasis without manifestation of cholangitis, p=0,001. The groups of patients were representative by the age (p=0,6), the sex (p=0,06), BMI (p = 0,4), the comorbidity (p=0,08), the degree of the surgical risk (ASA II, p=0,7; ASA III, p=0,06; ASA IV, p=0,06), the values of CA 19-9 (p=0,42). The difference between the groups was determined by diagnosed liver failure (LF) and protein-synthetic liver dysfunction: all patients of group A had LF: moderate LF was diagnosed in 52 (61,9 %) patients, severe one was diagnosed in 32 (38,1 %) patients. 8 (15,4 %) of the 52 patients in group B were diagnosed with hepatic insufficiency: moderate degree was diagnosed in 6 (11,5 %) patients and 2 (3,8 %) patients were diagnosed with severe degree, p<0,001. Disorders of protein-synthetic function (PSF) were diagnosed in 48/84 (57,1 %) patients of group A and in 9/52 (17,3 %) patients of group B, p<0,001. Disorders of PSF were diagnosed in 48/84 (57,1 %) patients of group A and in 9/52 (17,3 %) patients of group B, p<0,001. The groups differed in the duration of MOJ before hospitalization: it was 16 days (14-26 QI-QIII) in patients of group A and it was statistically and significantly different from the corresponding indicator of patients in group B – 3 days (2-4 QI-QIII), p=0,001; severity of MOJ: the median hyperbilirubinemia in the group with PBD was 271 μmol/l (227-296 QI-QIII) and it was 76 μmol/l (56-90 QI- QIII) in the group without PBD, p=0,001; the duration of the preoperative period, which was 16 days (13–21 QІ-QІІІ) in group A and 5 days (4-7 QI-QIII) in group B, p=0,001.
