ANTEGRADE ENDOBILIARY INTERVENTIONS IN PATIENTS WITH UNRESECTABLE BILIARY TRACT MALIGNANT NEOPLASMS COMPLICATED BY JAUNDICE
Authors: Boyko V. V. , Avdosyev Yu. V. , Yevtushenko D. O. , Sochneva A. L. , Taraban I. A. , Smachilo R. M. , Minukhin D. V. , Shevchenko O. M. 
Published: July 2023

Summary. Introduction. The causes of mechanical jaundice are benign and malignant diseases of the organs of the hepatopancreaticoduodenal zone. Literature sources describe the development of mechanical jaundice in 15-40 % of patients with gallstone disease and in the vast majority of patients with malignant neoplasms of the biliary tract. Mechanical jaundice of malignant etiology occurs in 40-67 % of patients.

Aim. To study the results of the use of antegrade endobiliary interventions in patients with unresectable malignant neoplasms of the biliary tract complicated by jaundice.

Materials and methods. An analysis of operative treatment of 62 patients with unresectable malignant neoplasms of the biliary tract, complicated by mechanical jaundice, classified according to Bishmuth-Corlette in the State Institution “Zaycev V.T. Institute of General and Emergency surgery of the National academy of medical sciences of Ukraine”: cholangiocarcinoma – tumor type I, observed in 9 (14.52 %) patients, type II – in 16 (25.81 %), type IIIA – in 10 (16.3 %), type IIIB – in 8 (12.9 %), type IV – in 13 (20.97 %). Cancer of the distal biliary tract was diagnosed in 6 (9.68 %) patients.

External-internal percutaneous transhepatic cholangiodrainage (group 1) was installed in 36 (58.1 %) patients, external percutaneous transhepatic cholangiodrainage was performed in 26 (41.9 %) patients (group 2).

Research results. Complications, which are directly related to the performance of percutaneous transhepatic cholangiodrainage, were found in 13 patients (21.0 %). In 7 (26.9 %) patients after external percutaneous transhepatic cholangiodrainage and in 6 (16.7 %) after external-internal percutaneous transhepatic cholangiodrainage (p>0.05).

Partial migration of cholangiodrainage was observed in 5 (8.06 %) patients.

Cholangiodrainage migration after percutaneous transhepatic cholangiodrainage of the left lobular duct occurred in 1 (1.6 %) patient. Cholangiodrainage migrated in 4 (6.4 %) patients with percutaneous transhepatic cholangiodrainage of the right lobular duct. Cholangitis after external-internal percutaneous transhepatic cholangiodrainage developed in 2 (3.2 %) patients, which was resolved due to sanitation and antibacterial therapy. Bile leakage into the abdominal cavity after percutaneous transhepatic cholangiodrainage in 1 (1.6 %) patient, which was resolved by placing a larger diameter drain. Hemobilia was observed in 2 (3.2 %) patients. In 3 (4.8 %) cases, the setting of the external percutaneous transhepatic cholangiodrainage was ineffective.

Conclusions. In the absence of anatomical and technical limitations, it is more effective to use external-internal drainage in the treatment of patients with unresectable malignant neoplasms of the biliary tract complicated by jaundice, which is more physiological and functional. Deep-internal percutaneous transhepatic cholangiodrainage is accompanied by a lower frequency of complications - 16.7 % compared to external percutaneous transhepatic cholangiodrainage - 26.9 %, the mortality rate for external-internal percutaneous transhepatic cholangiodrainage was 8.33 % compared to external percutaneous transhepatic cholangiodrainage — 11.54 %.