THE USE OF INTERCUTAL TRANSHEPATIC INTERVENTIONS IN MECHANICAL JAUNDICE OF TUMOR ORIGIN

Анотація

Introduction. The treatment of patients with obstructive jaundice of tumor etiology is connected with a high risk to patients` lives  and is followed by a high mortality level, which in the case of tumor obstruction of biliary system is 30,3-33%. That is why the decompression of the biliary tract is suggested at the first stage of treatment. Intercutal interventions will help to prepare the patients for the radical interventions and help inoperable patients and these methods do not give the alternative for the sarvation of hopeless patients.

Methods. The results of intercutal thanshepatic dreinage of 47 patients with mechanical jaundice of tumor etiology under the control of ultrasonography have been analysed. Intercutal transhepatic drairage of bile ducts (ITDBD) was conducted in 28 (59,6%) patients and itercutal transhepatic drainage of gallbladder (ITDG) in 19 (40,4%) patients. The indications for this drainage under the control of ultrasonography were mechanical jaundice, choleostasis syndrom, unbearable skin itching and cholangitis in case of patients with the head pancreas tumor, cholangiocarcinoma of the liver gate, metastases or enlarged lymph nodes in the liver gates in case of stomach cancer, cervix or breast cancer.

The results of research. Intercutal transhepatic intervention were conducted to restore radical operative intrusion; as the main method of treatment of patients with neglected forms of tumours and complicated anatomy of ventricle, duodenum, papilla and also for conduction of endoscopic transpapillar intervention.

Two methods of bile ducts drainage were used-  the two- step method of dreinage by Seldinger, mainly in case of patients with (ITDBD) and the one- step method of drainage with a stylet catheter, mainly of patients with (ITDG). ITDBD in 28 (59,6%) patients was used as the first stage for the drainage of the bile ducts before the radical operation for the function recovery of liver and homeostasis normalization, ITDG – in 19 (40,4%) patients with the neglected form of malignant tumor for the treatment of mechanical jaundice. Two methods of bile ducts drainage were used under the control of ultrasonography: the two-step method by Seldinger in case of 27 (96,4%) patients with ITDBD and 3 (15,8%) with ITDG and the one-step method of drainage with the help of stylet catheter 16 (84,2%) with ITDBG and one (3,7%) with ITDG.

Absolute contraindications to intercutal transhepatic bile ducts interventions were terminal state of the patient and the availability of ascites. Relevant contraindications are the absence of safe trajectory for the needle conduction or drainage, massive tumor lesion of liver with transhepatic bile ducts separation on segment level (IV type by Bismuth), severe violations in blood coagulation system.

The bile passage was restored, the manifistations of mechanical jaundice were reduced and the signs of cholangitis and skin itcing were eliminated in all patients. There were complications in 7 (14,9%) patients.

Conclusions. Minimally invasive intercutal transhepatic interventions are an effective way of withdrawl of bile in case of tumor obstruction of biliary system which helps to liquidate mechanical jaundice and normalize homeostasis, intercutal transhepatic drainage of gallbladder under the control of ultrasonography gives an opportunity to prepare patients for radical surgical interventions. It is necessary to work on further optimal surgical tactics in case of patients with mechanical jaundice of tumor genesis.