DIAGNOSIS AND TREATMENT OF MECHANICAL JAUNDICE OF TUMOR GENESIS IN THE CONDITIONS OF EMERGENCY HOSPITAL

Abstract

SUMMARY. It is known that malignant tumors of the periampullary zone are accompanied by the development of mechanical jaundice syndrome (MJ) in 75–95 % of cases, which can be both the first sign of the disease (65–70 %) and indicate its neglect and incurability. Mostly in the case of tumors of the head of the pancreas MJ is detected at the late stages of the disease, when radical interventions are already unlikely. The appearance of MJ significantly worsens the clinical course of the disease.

Patients with mechanical jaundice, including the one based on periampullary tumors, are usually first hospitalized in an urgent order to surgical departments, the task of which is to diagnose the causes of mechanical jaundice and effective decompression of the bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard in the diagnosis of diseases of the hepatopancreatobiliary zone.

The aim – to analyze the effectiveness of diagnostic methods and endoscopic minimally invasive surgical interventions on the patients with mechanical jaundice of an oncological nature in the conditions of an emergency hospital.

Material and Methods. 1,256 patients with obstructive jaundice syndrome were treated in the surgical department of the emergency hospital for the period 2018–2022. Gallstone disease prevailed in the structure of morbidity – 921 (73.3 %) patients. Tumors of the hepatopancreatoduodenal zone were found in 335 patients (26.7 %).

The diagnostic search algorithm included: general blood analysis, biochemical blood analysis, ultrasonography of the abdominal organs (ultrasonography of the abdominal cavity), spiral computer tomography with dose enhancement (CT), magnetic resonance cholangiopancreatography (MRCP), esophagogastroduodenoscopy (EFGDS) with retrograde cholangiopancreatography (ERCP).

Results. The clinic treated 335 patients with biliary obstruction syndrome of tumor etiology of the periampullary zone. Stenting was performed in 298 (92 %) patients using 8–10 Fr polypropylene stents 5–12 cm long and in 26 (8 %) patients partially and fully covered nitinol self-expanding 8 Fr stents 5–12 cm long. Procedural expediency of transpapillary biliary stenting under ERCP control is greater than 90 % with a short-term symptom relief efficacy of greater than 80 %.

Conclusions. 1. Among the causes of mechanical jaundice in patients hospitalized to an emergency hospital, 26.7 % are tumors of the hepatopancreatoduodenal zone. 29 % – extrahepatic bile duct tumors; 62.3 % – pancreatic tumors; 8 % of tumors of the large duodenal papilla.

1. Computed tomography, magnetic resonance cholangiopancreatography and retrograde pancreatocholangiography together are a highly effective method of diagnosing the nature and spread of malignant tumors of the hepatopancreatoduodenal zone in emergency care.
2. The effectiveness of endoscopic stenting in mechanical jaundice of an oncological nature is 96.7 %.
3. Endoscopic palliative decompression of the common bile duct in patients with tumors of the periampullary zone during the first 3–5 days after the intervention is accompanied by a significant decrease in hyperbilirubinemia.