Choice of treatment method of obstructive jaundice in patients with tumors of the hepatopancreatobiliary region

Abstract

The leading criteria for choosing minimally invasive surgical treatment of mechanical jaundice of tumor origin in the hepatopancreatobiliary zone are substantiated, which increase the effectiveness of surgical intervention and reduce the number of complications and mortality. The examination and surgical treatment results of 325 patients with mechanical jaundice of tumor origin, who underwent minimally invasive decompression of the biliary tract after clinical and laboratory diagnostics following national clinical recommendations, were analyzed. Based on the treatment results, the leading criteria that affect the selection of the method of minimally invasive drainage surgery are identified. The main criteria influencing the choice of minimally invasive intervention to decompress the bile ducts were as follows: level of bile duct block, severity of mechanical jaundice (according to the classification of E.I. Galperin), and the operability of the patient. Endoscopic stenting was the method of choice in inoperable cases at the level of block I with mechanical jaundice of classes A and B. Moreover, endoscopic stenting was the most successful intervention with a minimum number of complications in people with block II level. The indication for percutaneous transhepatic biliary drainage was a level III biliary tract block, as well as the ineffectiveness of endoscopic stenting. Cholecystostomy is the safest and most effective in patients with block level I with class C mechanical jaundice and in operable cases with the same block level. In general, results of surgical interventions aimed at eliminating mechanical jaundice of tumor origin, conducted using modern examination methods of patients and taking into account the assessment of criteria such as the block level of the bile ducts, severity of mechanical jaundice, and general condition allow us to justify the choice of the most successful and safe option for its elimination.