заведующий 3-м хирургическим отделением ГБУЗ АО “Первая городская клини-ческая больница им. Е.Е. Волосевич”.
Head of the Third Surgical Department, E.Е. Volosevich First City Clinical Hospital
канд. мед. наук, доцент кафедры хирургии ГБОУ ВПО СГМУ МЗ РФ, врач-хирург кабинета №2 отделения рентгенохирургических методов диагностики и лечения ГБУЗ АО “Первая городская клиническая больница им. Е.Е. Волосевич”
Cand. of Med. Sci., Associate Professor of Chair of Surgery of Northern State Medical University, Surgeon of the Second Unit of the Department of Endovascular Diagnosis and Treatment, Е.Е. Volosevich First City Clinical Hospital
канд. мед. наук, врач-эндоскопист кабинета №2 отделения рентгенохирургических методов диагностики и лечения ГБУЗ АО “Первая городская клиническая больница им. Е.Е. Волосевич”, ассистент кафедры хирургии ГБОУ ВПО СГМУ МЗ РФ
Cand. of Med. Sci., Endoscopist of the Second Unit of the Department of Endovascular Diagnosis and Treatment, Е.Е. Volosevich First City Clinical Hospital, Assistant of Chair of Surgery, Northern State Medical University.
канд. мед. наук, заместитель главного врача по хирургии ГБУЗ АО “Первая городская клиническая больница им. Е.Е. Волосевич”, ассистент кафедры хирургии ГБОУ ВПО СГМУ МЗ РФ
Cand. of Med. Sci., Deputy Chief Physician of Е.Е. Volosevich First City Clinical Hospital, Assistant of Chair of Surgery, Northern State Medical University
врач-эндоскопист кабинета №2 отделения рентгенохирургических методов диагностики и лечения ГБУЗ АО “Первая городская клиническая больница им. Е.Е. Волосевич”
Endoscopist of the Second Unit of the Department of Endovascular Diagnosis and Treatment, Е.Е. Volosevich First City Clinical Hospital
доктор мед. наук, заведующий кафедрой хирургии ГБОУ ВПО СГМУ МЗ РФ; заведующий кабинетом №2 отделения рентгенохирургических методов диагностики и лечения ГБУЗ АО “Первая городская клиническая больница им. Е.Е. Волосевич”
Doct. of Med. Sci., Head of Chair of Surgery of Northern State Medical University, Head of the Second Unit of the Department of Endovascular Diagnosis and Treatment, Е.Е. Volosevich First City Clinical Hospital
Aim. Determination of optimal method and study of results of minimally invasive biliary decompression in neoplastic obstructive jaundice.Materials and Methods. Biliary decompression was performed in 59 patients who were divided into groups of percutaneous drainage (n = 33) and transpapillary stenting (n = 26). In the second stage priority tactic of transpapillary biliary decompression was used in the prospective group of patients (n = 159).Results. Transpapillary and/or percutaneous biliary drainage was performed in all patients. There was high efficiency of cholestasis syndrome relief (serum bilirubin levels decreased by 39.2%, 53.9% and 77.0% at 3, 7 and 14 day after surgery respectively). Lower incidence of complications was revealed in patients after transpapillary decompression (n = 2; 7.7%)compared with percutaneous technique (n = 10; 30.3%, p = 0.032). Herewith clinical effectiveness and mortality were similar (p = 0.316). In the prospective group of 159 patients transpapillary stenting (n = 107; 63%) was ineffective in 31 case (29.9%), that required additional endoscopic treatment (n = 12) or percutaneous biliary drainage (n = 19). Mortality rate was 13.8% (22 patients).Conclusion. Endoscopic transpapillary stenting can be recommended in malignant obstructive jaundice management because of low incidence of complications and equal effectiveness and mortality. Percutaneous biliary drainage with primary or delayed recanalization of malignant stricture should be done if transpapillary stenting is impossible due to technical or anatomical aspects. The algorithm provides differentiated approach to choice of biliary decompressionmethod and improves treatment outcomes.
Aim. Determination of optimal method and study of results of minimally invasive biliary decompression in neoplastic obstructive jaundice.Materials and Methods. Biliary decompression was performed in 59 patients who were divided into groups of percutaneous drainage (n = 33) and transpapillary stenting (n = 26). In the second stage priority tactic of transpapillary biliary decompression was used in the prospective group of patients (n = 159).Results. Transpapillary and/or percutaneous biliary drainage was performed in all patients. There was high efficiency of cholestasis syndrome relief (serum bilirubin levels decreased by 39.2%, 53.9% and 77.0% at 3, 7 and 14 day after surgery respectively). Lower incidence of complications was revealed in patients after transpapillary decompression (n = 2; 7.7%) compared with percutaneous technique (n = 10; 30.3%, p = 0.032). Herewith clinical effectiveness and mortality were similar (p = 0.316). In the prospective group of 159 patients transpapillary stenting (n = 107; 63%) was ineffective in 31 case (29.9%), that required additional endoscopic treatment (n = 12) or percutaneous biliary drainage (n = 19). Mortality rate was 13.8% (22 patients).Conclusion. Endoscopic transpapillary stenting can be recommended in malignant obstructive jaundice management because of low incidence of complications and equal effectiveness and mortality. Percutaneous biliary drainage with primary or delayed recanalization of malignant stricture should be done if transpapillary stenting is impossible due to technical or anatomical aspects. The algorithm provides differentiated approach to choice of biliary decompressionmethod and improves treatment outcomes.
The authors declare that there are no conflicts of interest present.