CAPABILITIES OF PERCUTANEOUS TRANSHEPATIC DECOMPRESSION OF THE BILIARY TRACT IN OBSTRUCTIVE JAUNDICE

R.T. MAJIDOV, G.A. ABDURASHIDOV, E.P. MAMEDOV, A.Z. ABDULLAYEVA

Daghestan State Medical Academy, Makhachkala, RUSSIA

The aim of the study: To assess capabilities of percutaneous transhepatic method of biliary tract (BT) decompression in mechanical jaundice (MJ).

Materials and methods: The results of examination and treatment of 57 patients with MJ of tumor genesis: tumors of hilus localization (proximal obstruction BT) -20, tumors of the gallbladder with invasion of bile ducts (the central obstruction BT) -32; periampular tumors (distal obstruction BT) - 5 patients. Following invasive interventions: percutaneous transhepatic external drainage of BT under the radiographic-television guidance - 30; percutaneous transhepatic external drainage of BT under ultrasound-control -5; percutaneous transhepatic drainage external-internal BT under radiographic-television guidance -18; percutaneous transhepatic stenting of the bile duct - 4.

Comparison group included 54 patients with tumor occlusion of BT at different levels, which were performed biliodigestive anastomoses, external drainage of BT from a wide laporotomy and cholecystostomy.

Results and discussion: Technical success of percutaneous transhepatic BT decompression was observed in 55 (96.5%) cases. The best results were observed in external-internal drainage. In external drainage BT hyperbilirubinemia was eliminated less effectively and postdecompressive syndromes were more common. In the comparison group, in the immediate postoperative period, choleperitonitis of various prevalence developed in 6 (11.1%) patients based on bile leakage between drainages, or between inserted sutures in cases of proximal and central obstructions of the BT. 2 patients (3.7%) died of bile peritonitis. The main group of patients bile outflow into free abdominal cavity and cases of death were not observed.

Conclusions: Minimally invasive bile-withdrawing interventions for BT decompression are effective alternatives to laparotomic operations. The best way to resolve cholestasis in proximal and central obstructions is percutaneous transhepatic BT draining of bile ducts.

Date: 2014-12-28; view: 876