Treatment of Tumors Pancreatoduodenal Zone, Complicated by Obstructive Jaundice Using Biliary Decompression

Abstract

The aim of the research. To develop an algorithm for the two-stage treatment of patients with tumors pancreatoduodenal zone complicated by obstructive jaundice using biliary decompression techniques at the first stage and conducting pancreatoduodenal resection at the second stage of treatment.
 Materials and methods. Preliminary biliary decompression was conducted in 51 patients with prolonged obstructive jaundice and high bilirubin numbers (above 250 μmol/l). The following minimally invasive options were used for biliary decompression: percutaneous transhepatic cholangio-drainage in 21 (41.2 %), endoscopic stenting in 18 (35.3 %), various cholecystostomy (percutaneous transhepatic, contact, video laparoscopic) in 12 (25, 8 %) patients. A two-stage method has been developed for the treatment of pancreatic tumors complicated by obstructive jaundice.
 Results. Percutaneous transhepatic cholangio-drainage was performed under ultrasound-X-ray navigation — in 11 (52.4 %), under angiographic control — in 10 (47.6 %) patients. Endoscopic stenting was performed in 18 (35.3 %) patients; plastic stents were used. Three options were used for pancreatojejunoanastomos: invagination ductopancreatojejunal — in 31 (60.8 %), invagination pancreatojejunal — in 16 (31.4 %), pancreatojejunal with bandage plasty of the crescent ligament of the liver — in 4 (7.8 %) patients. Diagnosis of pancreatic fistula was carried out according to the classification of ISGPF (2016). Biochemical leak was observed in 3 (5.9 %), pancreatic fistula (type B) in 2 (3.9 %) patients. Post-operative gastrostasis was detected in 3 (5.9 %) patients.
 Conclusions. Percutaneous transhepatic cholangio-drainage and endoscopic stenting are the most effective methods of biliary decompression. The use of biliary decompression in patients with pancreatic tumors complicated by the development of obstructive jaundice allows patients to prepare for the execution of PDR with reduced perioperative risk.