Dynamics of cytolytic and cholestatic syndromes in patients with diseases Of the biliopancreatoduodenal area under conditions of different preoperative preparation

Authors

  • P. T. Muraviov Odesa National Medical University MUI “ORCMC” of the Odesa Regional Council
  • B. S. Zaporozhchenko Odesa National Medical University MUI “ORCMC” of the Odesa Regional Council
  • I. Ye. Borodaev Odesa National Medical University MUI “ORCMC” of the Odesa Regional Council
  • V. H. Shevchenko Odesa National Medical University MUI “ORCMC” of the Odesa Regional Council
  • Harhouri Makrem Odesa National Medical University

DOI:

https://doi.org/10.11603/2414-4533.2021.4.12442

Keywords:

obstructive jaundice, biliary drainage, pancreatoduodenal resection, chronic pancreatitis, pancreatic cancer

Abstract

The aim of the work: to evaluate the dynamics of manifestations of cytolytic and cholestatic syndromes in patients with focal diseases of the biliopancreatoduodenal area complicated by the syndrome of mechanical jaundice, under conditions of different preoperative preparation.

Materials and Methods. The results of surgical treatment of 272 patients who underwent pancreatoduodenal resection in various modifications for focal diseases of the biliopancreatoduodenal area complicated by the development of obstructive jaundice syndrome were analyzed. The main group included 112 patients, who were prepared for surgery and predicted the course of the postoperative period according to the developed algorithm. The comparison group included 160 patients, who were prepared only in a conservative way.

Results and Discussion. Due to the application of the developed algorithm of preoperative preparation, the average values ​​of alanine aminotransferase on the 5th day decreased to (151±15) U/l in the main group against (188±13) U/l in the comparison group. On the seventh day, the differences persisted, gained reliability and amounted to (119±12) U/l and (157±14) U/l in the main group and in the comparison group, respectively (p<0.05). On the eve of the operation, the indicator was (101±11) U/l and (138±12) U/l in the main group and the comparison group, respectively (p<0.05). Aspartate aminotransferase activity on the 3rd day decreased in the main group from (204±12) (on admission to the hospital) U/l to (153±11) U/l, and in the control group – from (186±14) U/l (on admission to the hospital) up to (161±9) U/l. The difference between the compared groups became significant and began to gain reliability from the 5th day (124±13) U/l against (150±11) U/l in the main and comparison groups, respectively (p<0.05). On the eve of pancreatoduodenal resection, the difference was also significant – (81±7) U/l against (114±7) U/l in the main group and the comparison group, respectively (p<0.05). Regarding the content of alkaline phosphatase, on the 3rd day of observation in both groups there was a decrease in activity to (440.9±2.1) and (550.7±1.4) U/l (p<0.05). On the 5th day of observation, the values ​​of the indicator were even smaller, and in the main group there was a more significant decrease in its activity (223.2±2.7) U/l compared with the comparison group (350.3±1.1) U/l (p<0.05). Finally, on the eve of the operation, the activity of the indicator was (104.8±1.3) U/l in the main group, and (270.8±1.9) U/l in the comparison group (p<0.05). Dynamics of changes in activity of γ-glutamyltransferase on the 3rd day of the study, the values ​​of the indicator in the main group and the comparison group decreased to (511±38) U/l and (554±31) U/l, respectively. The differences became more significant on the 5th day – (403±29) U/l against (446±35), and became significant on the 7th day – (304±21) U/l against (374±26) U/l in the main group and the comparison group, respectively (p<0.05). On the eve of surgery, a further decrease in the indicator retained its reliability (271±29) U/l in the main group against (348±33) U/l in the comparison group (p<0.05).

References

Elbanna, K.Y., Jang, H.J., & Kim, T.K. (2020). Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging, 11 (1), 58. DOI: https://doi.org/10.1186/s13244-020-00861-y.

Aguilera F., Tsamalaidze, L., & Raimondo M. (2018). Pancreaticoduodenectomy and outcomes for groove pancreatitis. Dig. Surg., 35 (6), 475-481. DOI: 10.1159/000485849.

Mihajlichenko, V.Ju., Kisljakov, V.V., & Reznichenko, A.M. (2019). Sovremennye aspekty hirurgicheskogo lecheniya sindroma mehanicheskoy zheltuhi [Modern aspects of the mechanical jaundice syndrome surgical treatment]. Sovremennye problemy nauki i obrazovaniya – Modern Aspects of Science and Education, 3, 78- 83 [in Russian].

Kanikovskyi, O.Ye., Pavlyk, I.V., & Oliinyk, I.V. (2018). Alhorytm khirurhichnoho likuvannia uskladnenykh form khronichnoho pankreatytu [Algorithm of complicated chronic pancreatitis surgical treatment]. Medychni perspektyvy – Medical Perspectives, 23, 4, 79-84 [in Ukrainian].

Cloyd, J.M., Katz, M.H.G., & Prakash, L. (2017). Preope­rative therapy and pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a 25-year single-institution experience. J. Gastrointest. Surg., 21 (1), 164-174. DOI: https://doi.org/10.1007/s11605-016-3265-1.

Bassi, C., Marchegiani, G., & Giuliani, T. (2021). Pancreatoduodenectomy at the Verona Pancreas Institute: the evolution of indications, surgical techniques and outcomes: a retrospective analysis of 3000 consecutive cases. Ann. Surg., DOI: 10.1097/sla.0000000000004753.

Klaiber, U., Probst, P., & Hüttner, F.J. (2020). Randomized trial of pylorus-preserving vs. pylorus-resecting pancreatoduodenectomy: long-term morbidity and quality of life. J. Gastrointest Surg., 24 (2), 341-352. DOI: 10.1007/s11605-018-04102-y.

Schorn, S., Demir, I.E., Vogel, T., Schirren, R., Reim, D., Wilhelm, D., ..., & Ceyhan, G.O. (2019). Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy – a systematic review with meta-analysis. Langenbecks Arch. Surg., 404 (2), 141-157. DOI: 10.1007/s00423-019-01762-5.

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Published

2022-02-18

How to Cite

Muraviov, P. T., Zaporozhchenko, B. S., Borodaev, I. Y., Shevchenko, V. H., & Makrem, H. (2022). Dynamics of cytolytic and cholestatic syndromes in patients with diseases Of the biliopancreatoduodenal area under conditions of different preoperative preparation. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (4), 78–84. https://doi.org/10.11603/2414-4533.2021.4.12442

Issue

No. 4 (2021)

Section

EXPERIENCE OF WORK

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