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
DOI:
https://doi.org/10.11603/2414-4533.2018.4.9702Keywords:
laparoscopic decompression, obstructive cholestasis, periamapal tumor, markers of cholestasisAbstract
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.
References
Ishihara, S., & Horiguchi, A. (2015). Epidemiology of biliary tract cancer – comparison with other country. Nihon Rinsho, 73 (3), 466-470.
Morine, Y., & Ishibashi, H. (2014). Nation wide survey of pancreaticobiliary maljunction. Nihon Shokakibyo Gakkai Zasshi, 111, 4, 699-705.
Malyarchuk, V.I., Klimov, A.Ye., & Pautkin, Yu.F. (2009). Biliopankreatoduodenalnyy rak [Biliopancreatoduodenal cancer]. Moscow: Ros. un-t druzhby narodov [in Russian].
Khrustaleva, M.V., & Gallinger, Yu.I. (2001). Endoskopicheskoye transpapillyarnoye duodenobiliarnoye drenirovaniye v lechenii mekhanicheskoy zheltukhi [Endoscopic transpapillary duodenobiliary drainage in the treatment of obstructive jaundice]. Annaly Ros. nauch. tsentra khirurgii RAMN – Annals of Russian Scientific Center of Surgery RAMS, 10, 45-48 [in Russian].
Yeliseyev, S.M., Kornilov, N.G., Chikoteyev, S.P., & Gumerov, R.R. (2010). Obosnovaniye khirurgicheskoy taktiki pri mekhanicheskoy zheltukhe (analiticheskiy obzor literatury) [Justification of surgical tactics in obstructive jaundice (analytical review of literature)]. Byul. VSNTS SO RAMN – Bulletin of the E-SSC of the SB RAMS, 5, 233-239 [in Russian].
Mikhaylova, S.A. (2006). Dreniruyushchiye posobiya pri mekhanicheskoy zheltukhe opukholevoy etiologii [Drainage aids for obstructive jaundice of tumor etiology]. Palliativ. meditsina i reabilitatsiya – Palliative Medicine and Rehabilitation, 2, 22 [in Russian].
Nikitin, N.A., Podgornyy, L.Yu., & Drozdov, A.G. (2002). Laparoskopicheskoye chreskozhno-chrespechenochnoye drenirovaniye zhelchnogo puzyrya u bolnykh mekhanicheskoy zheltukhoy [Laparoscopic percutaneous-transhepatic drainage of the gallbladder in patients with obstructive jaundice]. Vyatsk. med. vestnik – Vyatsk Medical Journal, 1, 27 [in Russian].
Konovalov, D.Yu., Gumerova, E.I., Amanturliyeva, M.Ye. (2014). Sravnitelnaya otsenka khirurgicheskogo lecheniya bolnykh s sindromom mekhanicheskoy zheltukhi opukholevoy etiologii [Comparative evaluation of surgical treatment of patients with obstructive jaundice syndrome of tumor etiology]. Akt. probl. gumanitar. i yestestv. nauk – Actual Problems of Humanitarian and Natural Sciences, 1-2, 188-192 [in Russian].
Downloads
Published
Issue
Section
License
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
