hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1995-5464.2019210-24hepato-505Research ArticleМИНИИНВАЗИВНЫЕ ТЕХНОЛОГИИ ПРИ МЕХАНИЧЕСКОЙ ЖЕЛТУХЕMINIMALLY INVASIVE TECHNOLOGIES FOR OBSTRUCTIVE JAUNDICEДифференцированный подход к применению минимально инвазивных методов лечения опухолевой механической желтухиDifferentiated approach to the minimally invasive management of malignant obstructive jaundicehttps://orcid.org/0000-0001-5088-5538ГальперинЭ. И.GalperinE. I.

Гальперин Эдуард Израилевич – доктор мед. наук, профессор кафедры госпитальной хирургии ФГАОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава России (Сеченовский Университет), Почетный президент Ассоциации гепатопанкреатобилиарных хирургов стран СНГ

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Eduard I. Galperin – Doct. of Sci. (Med.), Professor of the Chair of Hospital-Based Surgery, Sechenov First Moscow State Medical University (Sechenov University)

8, bld. 2, Trubetskaya str., Moscow, 119991

edgalp@mail.ruhttps://orcid.org/0000-0002-5011-4853АхаладзеГ. Г.AkhaladzeG. G.

Ахаладзе Гурам Германович – доктор мед. наук, профессор, главный научный сотрудник научно-исследовательского отдела хирургии и хирургических технологий в онкологии ФГБУ РНЦРР Минздрава России

117997, Москва, ул. Профсоюзная, д. 86. Тел.: +7-903-590-06-86

Guram G. Akhaladze – Doct. of Sci. (Med.), Professor, Chief Research Fellow of Scientific Department of Surgery and Surgical Technologies in Oncology, Russian Scientific Center of Roentgenoradiology

86, Profsoyusnaya str., Moscow, 117997

Phone: +7-903-590-06-86

gur371ax@gmail.comhttps://orcid.org/0000-0001-8489-2568ВетшевП. С.VetshevP. S.

Ветшев Петр Сергеевич – доктор мед. наук, профессор, советник по клинической и научной работе ФГБУ “НМХЦ им. Н.И. Пирогова” Минздрава России, Заслуженный врач РФ, председатель координационного совета “Миниинвазивные технологии под контролем УЗИ и РТВ” Ассоциации гепатопанкреатобилиарных хирургов стран СНГ

105203, Москва, ул. Нижняя Первомайская, д. 70

Peter S. Vetshev – Doct. of Sci. (Med.), Professor, Deputy Chief Executive Officer for Medical and Scientific Work of the Pirogov National Medical Surgical Center, Honored Doctor of the Russian Federation, Chairman of the Coordination Council “Minimally invasive technologies under ultrasound and X-ray assistance” of the Association of Hepatopancreatobiliary Surgeons of the CIS countries

70, str. Nizhnyaya Pervomayskaya, Moscow, 105203

p.vetshev@mail.ruhttps://orcid.org/0000-0003-0573-7573ДюжеваТ. Г.DyuzhevaT. G.

Дюжева Татьяна Геннадьевна – доктор мед. наук, профессор кафедры госпитальной хирургии ФГАОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава России (Сеченовский Университет)

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Tatyana G. Dyuzheva – Doct. of Sci. (Med.), Professor of the Chair of Hospital-Based Surgery, Sechenov First Moscow State Medical University (Sechenov University)

8, bld. 2, Trubetskaya str., Moscow, 119991 

dtg679@gmail.comКафедра госпитальной хирургии лечебного факультета ФГАОУ ВО Первый Московский государственный медицинский университет им. И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияChair of Hospital-Based Surgery, Faculty of Medicine of the Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian FederationФГБУ “Российский научный центр рентгенорадиологии” Минздрава РоссииРоссияRussian Scientific Center of Roentgenoradiology of the Ministry of Health of RussiaRussian FederationФГБУ “Национальный медико-хирургический центр им. Н.И. Пирогова” Минздрава РоссииРоссияPirogov National Medical Surgical Center of the Ministry of Health of RussiaRussian Federation2019200620192421024Copyright © Гальперин Э.И., Ахаладзе Г.Г., Ветшев П.С., Дюжева Т.Г., 20192019Гальперин Э.И., Ахаладзе Г.Г., Ветшев П.С., Дюжева Т.Г.Galperin E.I., Akhaladze G.G., Vetshev P.S., Dyuzheva T.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/505

Отношение к предоперационному билиарному дренированию (ПБД) при опухолевой механической желтухе за последнее время дважды менялось. Это обусловлено такими факторами, как осложнения минимально инвазивных методов ПБД, уровень блока желчных протоков, холангит, необходимость проведения неоадъювантной химиотерапии, срок до планируемой операции, тяжелое общее состояние больного, величина будущего остатка печени при планируемой резекции. В медицинских поисковых системах PubMed, MD Consult и National Library of Medicine изучили публикации по ключевым словам “механическая желтуха (МЖ)”, “клеточный иммунитет”, “предоперационное билиарное дренирование”, “селективное билиарное дренирование”, “дистальный и проксимальный блок желчных протоков”, “осложнения”. Ориентировались в основном на рандомизированные клинические исследования и метаанализы, мнения авторитетных специалистов в гепатопанкреатобилиарной хирургии, а также результаты собственных экспериментальных и клинических исследований. Анализ показал, что ПБД не является безопасной процедурой и его применение связано с увеличением числа осложнений. К абсолютным показаниям к ПБД следует отнести холангит, необходимость проведения неоадъювантной химиотерапии, повышенный риск радикальной операции и нерезектабельную опухоль. При уточнении показаний к ПБД при проксимальном блоке, вызванном воротной холангиокарциномой, следует ориентироваться на объем и функциональное состояние будущего остатка печени.

Attitude towards preoperative biliary drainage for malignant obstructive jaundice have recently changed twice. This is due certain factors including complications of minimally invasive biliary drainage, level of bile duct block, cholangitis, need for neoadjuvant chemotherapy, time to scheduled surgery, severe general condition of patient, future liver remnant volume. We comprehensively searched PUBMED, MD Consult and National Library of Medicine using the following keywords: “obstructive jaundice (OJ)”, “cellular immunity”, “preoperative biliary drainage”, “selective biliary drainage”, “distal and proximal bile duct block”, “complications”. Randomized clinical trials and meta-analyzes, opinions of reputable specialists in hepatopancreatobiliary surgery and our own experimental and clinical studies were foreground. The analysis showed that preoperative biliary drainage is not a safe procedure and results an increased number of complications. Absolute indications for preoperative biliary drainage are cholangitis, need for neoadjuvant chemotherapy, increased risk of radical surgery and unresectable tumor. Future liver remnant volume should be considered in patients with portal cholangiocarcinoma followed by proximal block to determine indications for preoperative biliary drainage.

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The authors declare that there are no conflicts of interest present.