Дифференцированный подход к применению минимально инвазивных методов лечения опухолевой механической желтухи

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.

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