Biliary decompression in patients with obstructive jaundice

Коробка, В. Л.; Толстопятов, С. В.; Даблиз, Р. О.; Shapovalov, A. M.

doi:10.35401/2500-0268-2019-16-4-24-31

Cited by 5 publications

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References 5 publications

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“…Тяжесть осложнений МЖ зависит от уровня обструкции и длительности гипербилирубинемии. Поэтому механическая желтуха должна быть, безусловно, устранена в наиболее ранние сроки желчеотведением одним из известных способов: хирургическим, пункционным, эндоскопическим, сочетанным [10]. Выбор оптимальной тактики во многом зависит от технических и методологических особенностей способа дренирования желчных путей, от общего состояния пациента на момент обращения, опыта врача в проведении данных вмешательств и, несомненно, должен проводиться с учетом развития возможных осложнений.…”

Section: оригинальные исследования введениеunclassified

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

Васин¹,

Omelchenko

2023

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. The most pressing problems in abdominal oncology surgery are the development of obstructive jaundice as a complication in patients with malignant tumors in the hepatobiliary and pancreatoduodenal area, and the ways to eliminate it and to reduce the risk of adverse events. Our earlier research revealed 14 predictors that together are more likely to cause undesirable postoperative complications, including deaths during minimally invasive biliary tract decompression. On the basis of the data obtained, a computer program “Risk Assessment of Treatment Methods for Obstructive Jaundice” was created.Materials and methods. The program was introduced into clinical practice in Yaroslavl Regional Clinical Oncology Hospital and was tested on 144 patients from 2019 through 2022. Th e program issued a conclusion on the risk of adverse events and assigned the patient to one of the groups where drainage or stenting were recommended for the first stage of biliary tract decompression.Results and discussion. Following a collegial decision based on the results obtained via the program, 58 patients (40.28 %) underwent endoscopic stenting and 86 patients (59.72 %) underwent percutaneous transhepatic biliary drainage. In the study group, adverse events developed in 10 patients (6.94 %), while in the control group — in 50 patients (22.94 %), and 134 patients (93.06 %) had no complications, as compared to 168 patients (77.06 %) in the control group.Conclusion. Application of the program based on reliable and practically significant 14 predictors results in a decline in general complications induced by minimally invasive biliary tract decompression from 22.94 % to 6.94 % and a 3.5-fold decrease in mortality from 5.05 % to 1.39 % in patients with malignant neoplasms in the hepatobiliary and pancreatoduodenal area, complicated by obstructive and mixed jaundice.

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Section: оригинальные исследования введениеunclassified

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

Васин¹,

Omelchenko

2023

Kreativnaâ hirurgiâ i onkologiâ

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Endoscopically non-removable stones of the common bile duct

Shevchenko¹,

Al-Kanani²,

Yarosh³

et al. 2022

Khir. Z. im. N.I. Pirogova

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Prevention and correction of postdecompression liver dysfunction in obstructive jaundice in experimental animals

Магомедов

Khamidov

Magomedov

et al. 2021

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Obstructive jaundice is a complex pathology that significantly complicates surgical interventions and is accompanied by a number of negative consequences. In connection with the danger of obstructive jaundice, it is very important to timely identify the severity of this condition and take appropriate measures to treat the patient. To date, methods for predicting the risk of postoperative complications in obstructive jaundice are being actively developed, and methods for treating this pathology are being developed. In this study, we studied the biochemical parameters of the functional state of the liver of dogs with simulated obstructive jaundice with different treatment regimens. 3 experimental groups were formed. Control dogs received no treatment. The dogs of the second group underwent decompression of the biliary tract without control of the rate of bile outflow. In animals of the third group, decompression of the biliary tract was carried out and the rate of bile outflow was controlled. As therapy, dogs of this experimental group received Cytoflavin (0.28 ml / kg body weight) and sulodexide (1 ml / kg body weight) under conditions of moderate hypothermia. All animals underwent laparotomy with puncture of the gallbladder and subsequent introduction of a catheter through the cystic duct into the common bile duct. Blood from the portal vein and lymph from the main lymphatic were taken for the analysis of the following biochemical parameters: direct bilirubin, C-reactive protein, alanine aminotransferase, gamma-glutamyl transferase and glucose. The concentration of the listed indicators of the functional state of the liver was assessed at different times after the simulation of obstructive jaundice. The results of the study showed that in dogs of all groups, one day after modeling obstructive jaundice, biochemical parameters significantly increase both in the blood of the portal vein and in the lymph of the thoracic lymphatic duct, which is associated with a violation of the functional state of the liver. In animals in which the rate of bile outflow was not controlled, biochemical parameters remained at a high level, which reflected the development of liver failure and reperfusion syndrome. After administration of cytoflavin and sulodexide in moderate hypothermia, dogs showed a decrease in the concentration of biochemical parameters to the control level, which characterizes the normalization of the functional state of the liver. In general, the proposed treatment regimen has shown high efficiency and can be used to correct post-decompression liver dysfunction in dogs with obstructive jaundice. The results of the study are valuable for the development of methods for treating patients with obstructive jaundice and preventing the development of postoperative complications. This article can be informative for specialists in the field of surgery and anesthesiology who are involved in the correction of postoperative complications in patients with obstructive jaundice.

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Biliary decompression in patients with obstructive jaundice

Cited by 5 publications

References 5 publications

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

Endoscopically non-removable stones of the common bile duct

Prevention and correction of postdecompression liver dysfunction in obstructive jaundice in experimental animals

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