Dynamics of indicators of hepatodepressive cytolytic and cholestatic syndrome and the incidence of complications in patients with mechanical jaundice of tumor genesis after endoscopic and laparoscopic preoperative decompression of the common bile duct

Abstract

The aim of the work: to find out the dynamics of indicators of hepatodepressive, cytolytic and cholestatic syndromes, as well as the frequency of complications in patients with mechanical jaundice of tumor genesis after endoscopic and laparoscopic preoperative decompression of the common bile duct.

Materials and Methods. The basis of the work is the analysis of histories of diseases of 60 patients with tumors of the biolipanceratoduodenal zone with a mechanical jaundice syndrome that was treated at the State Medical Service "National Institute of Surgery and Transplantology named after O. Shalimov" NAMS of Ukraine from 2011 to 2017. The bile duct as the first – the preparatory stage with subsequent radical surgical intervention with laparotomic access. In the first group, endoscopic decompression of the biliary tract was performed, the catheter was retrograded through a large duodenal papilla. In the second group, they performed laparoscopic cholecystectomy, and then the catheter was initiated concurrently through the bladder duct. Additionally, through the right hypochondrium drained the bed of the gall bladder. The main surgical intervention was performed not earlier than after 14 days. All patients underwent general clinical, special, laboratory and instrumental methods of examination. Before the operation, as well as in 3, 7 and 14 days in blood serum of patients, known markers of gepatodepressive, cytolytic and cholestatic syndromes were determined: total bilirubin content, alanine aminotransferase (ALT) activity, alkaline phosphatase (LF), prothrombin time, as well as the frequency of complications in the remote postoperative period.

Results and Discussion. In all patients with obstructive cholestasis of tumor origin at the time of hospitalization there was an increase in indicators – markers of hepatodepressive, cytolytic and cholestatic syndromes. In the course of decompression, the activity of serum ALT and LF significantly decreased to 14 days, the content of total bilirubin decreased, as well as the amount of prothrombin time that did not reach the level of the generally accepted norm. For most of the studied cholestasis markers, the effectiveness of both methods of decompression of the common bile duct was practically the same, however, the amount of prothrombin time after laparoscopic decompression in 14 days was significantly lower. In the remote postoperative period after the laparoscopic decompression, the incidence of complications was 5.33 times lower than after endoscopic intervention, which allows for the advent of a wider introduction of laparoscopic technologies for the purpose of decompression of the biliary tract as a first step before the radical removal of the tumors of the bialiopancreatoduodenal zone.