Some Features of Cholestasis in Cancer Patients During the Reduction of Liver Functional Reserves

Abstract

Purpose. To determine the indications for the supra - and transpapillary externally-internal drainaging of the biliary tree in case of jaundice syndrome. Material and methods. The results of minimally invasive treatment of 246 patients with external-internal drainage of the biliary tree were analyzed. Among patients with proximal tumor block the external-internal drainage is made in 92 cases, in 42 (45,7%) out of them in suprapapillary embodiment and in 50 (54,3%) - via transpapillary approach. In 154 cases with distal tumor (obstruction peripapillary cancer) transpapillary drainage was performed. Results. The technical success of the external-internal drainaging was achieved in 242 patients (98,4%). It was failed to pass the duodenum in 4 patients with the cancer of common bile duct (3) and cancer of papilla of Vater (1). There was no complications related to the technique of external-internal drainage. In 18 patients (8,8%) out of 204 with transpapillary location of the drainage, we were forced to temporarily return to full outer bile outflow because of acute cholangitis. The syndrome of an acute blockade of the papilla of Vater arising after transpapillary external-internal drainaging required endoscopic papillosphincterotomy in 42 (84%) out of 50 patients with proximal tumor block bile outflow and in 7 (4.5%) out of 154 patients with peripapillary cancer. Conclusion. Suprapapillary and transpapillary embodiment of the drainage are equivalent in terms of the efficacy of cholestasis elimination. Syndrome of an acute blockade of papilla of Vater is the most often complication of the transpapillary external-internal drainage requiring the carrying out of endoscopic papillotomy «on drainage». This syndrome arises very frequently in a case of transpapillary external-internal drainage due to the proximal tumor obstruction of the biliary tree. The risk of acute cholangitis due to regurgitation after manipulation is absent in the suprapapillary location of the external-internal drainage, and with its transpapillary position is realized only with a concomitant violation of the outflow of bile.