Novosti
Khirurgii

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Year 2015 Vol. 23 No 5

EXCHANGE OF EXPERIENCE

Y.V. STRUCHKOV, A.G. KURMANBAEV

ANTEGRADE DRAINAGE OF THE BILIARY TRACT IN PATIENTS WITH UNRESECTABLE TUMORS OF BILIOPANCREATODUODENAL ZONE COMPLICATED BY OBSTRUCTIVE JAUNDICE

SBEE HPE "I.M. Sechenov First Moscow State Medical University",
Moscow
The Russian Federation

Objectives. To evaluate the efficacy of transcutaneous transhepatic biliary drainage in patients with cholestasis of malignant etiology.
Methods. The treatment results of 55 patients with unresectable tumors of biliopancreatoduodenal zone complicated by obstructive jaundice have been analyzed. The antegrade drainage of the biliary tract was performed under ultrasonic and fluoroscopic guidance. The method effectiveness was evaluated according to dynamics of levels of total bilirubin, liver enzymes – alanine transaminase (ALT) and aspartate transaminase (AST) according to multiple organ dysfunction score (MODS II), simplified acute physiology score (SAPS II), and a diameter of the common bile duct. These values were analyzed on admission, on the first, fifth and tenth day after application of transcutaneous transhepatic cholangiostomy.
Results. Since the first day of transcutaneous transhepatic cholangiostomy after antegrade drainage of the bile ducts the total bilirubin level reduced from 185±22 μmol/l to 113±13 μmol/l. On the fifth day the levels of liver enzymes ALT and AST declined from 198±22 U/l to 86±11 U/l and 161±20 U/l to 63±7 U/l, respectively.
On the fifth day the the condition of patients has improved according to the scale MODS II (from 4,2±0,3 to 2,2±0,2 points) and the scale SAPS II (38±1,7 to 26±1,5 points). The reduction of hypertension in bile duct characterized by a decrease of the common bile duct diameter from 14,1±1,2 mm to 8,9±0,6 mm was registered on the fifth day. No complications and deaths immediately related to the use of transcutaneous transhepatic cholangiostomy were noted.
Conclusion. Transcutaneous transhepatic cholangiostomy allows eliminating the signs of hypertension in the biliary tract. Mortality is due directly to the main oncologic disease, cancer intoxication, and comorbidities.

Keywords: malignant tumors, biliopancreatoduodenal zone, transpercutaneous transhepatic drainage of choledoch, scales of severity, hyperbilirubinemia, alanine aminotransferase, aspartate aminotransferase, complications
p. 570-576 of the original issue
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Address for correspondence:
109240, Rossiiskaia Federatsiia,
g. Moskva, ul. Iauzskaia d. 11.
str. 1, GKB im. I.V. Davydovskogo,
GBOU VPO "Pervyi moskovskii go
sudarstvennyi meditsinskii universitet
imeni I.M. Sechenova", kafedra obshchei khirurgii
e-mail: azamatkg.88@gmail.com,
Kurmanbaev Azamat Gul'tashyrovich
Information about the authors:
Struchkov Y.V. MD, professor, a senior researcher of the general surgery chair of SBEE HPE "I.M. Sechenov First Moscow State Medical University".
Kurmanbaev A.G. A post-graduate student of the general surgery chair of SBEE HPE "I.M. Sechenov First Moscow State Medical University".
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