Спорные вопросы билиарной декомпрессии при механической желтухе опухолевого генеза

В настоящее время стратегия предоперационного лечения пациентов с механической желтухой опухолевого генеза не определена. Продолжаются дискуссии о показаниях к желчеотведению, выборе метода билиарного дренирования и его продолжительности. Анализ международных исследований показал, что рутинное предоперационное дренирование “по умолчанию” не рекомендовано. Показания к билиарному дренированию при резектабельном процессе определяют по тяжести механической желтухи, холангиту, срокам предстоящей операции, а при проксимальном уровне билиарного блока – по типу опухоли по Bismuth–Corlette. Выбор антеградного или ретроградного способа предоперационного желчеотведения зависит от уровня билиарного блока и возможностей лечебного учреждения. В большинстве исследований показано, что предпочтительными являются  ретроградные (эндоскопические) способы при дистальном блоке и антеградные (чреспеченочные) – при проксимальном. Сроки предоперационного дренирования зависят от нормализации показателей биохимического анализа крови. Увеличение продолжительности дренирования может способствовать развитию ранних послеоперационных осложнений. Оптимальным сроком считают 2 нед. Для успешного лечения больных механической желтухой опухолевого генеза необходимо максимально достоверно определить причину ее развития, что позволяет выработать стратегию и тактику в конкретной клинической ситуации. Целесообразность и способ билиарной декомпрессии следует рассматривать в соответствии с выбранной стратегией лечения пациента.

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