The preoperative preparation peculiarities of patients with focal diseases Of the bilopancreaticoduodenal zone, complicated by mechanical jaundice
DOI:
https://doi.org/10.11603/2414-4533.2021.3.12549Keywords:
obstructive jaundice, biliary drainage, pancreatoduodenal resection, chronic pancreatitis, pancreatic cancerAbstract
The aim of the work: to compare the effectiveness of existing methods of jaundiced patients with focal diseases of the biliopancreatoduodenal zone preparing to the pancreatoduodenal resection performing, and to determine the effectiveness of the applied methods of biliary decompression.
Materials and Methods. The results of surgical treatment of 272 patients who underwent pancreatoduodenal resection in various modifications for focal diseases of the biliopancreatoduodenal zone 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 detoxification algorithm with the use of biliary decompression in patients of the main group on the third day, the level of bilirubinemia averaged (185.1±2.4) μmol/L, while on the fifth day it was already (163.2±2.6) μmol/L and on the eve of pancreatoduodenal resection – (112.3±2.7) μmol/L. In the comparison group, where the preparation of patients for radical surgery was carried out only by conservative measures without biliary drainage, the initial level of total bilirubin was (270.6±4.6) μmol/L, on the third day – (258.4±2.9) μmol/L, on the fifth – (222.2±3.8) μmol/L, and on the eve of pancreatoduodenal resection – (198.3±3.3) μmol/L. Thus, in the main group after decompression, the decrement of the total bilirubin level was ∆ = -59.1. But in the comparison group on the eve of pancreatoduodenal resection, the decrement of the total bilirubin level was ∆ = -26.7. After pancreatoduodenal resection performing, the decrement of bilirubinemia in both groups did not exceed 40 % and was (32.7±2.8) % in the main group, and (27.4±1.6) % in the control group. When comparing measures for the correction of biliary hypertension in patients of the main group, in all subgroups, starting from the 3rd day, a gradual decrease in the concentration of bilirubin was observed, more expressed in patients who underwent percutaneous transhepatic cholangiostomy (164±18 μmol/L, p <0.05). On average, on day 9, a significant decrease in total bilirubin parameters was determined after percutaneous transhepatic cholangiostomy by 41.2 %, laparoscopic cholecystostomy by 13.6 % and after puncture cholecystostomy by 6.6 % (p <0.05).
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