Медицинская литература. Новинки

 

 

 

 

 

 

Ранние билиарные осложнения панкреатодуоденальной резекции

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Проведен обзор современных зарубежных публикаций, посвященных ранним билиарным осложнениям панкреатодуоденальной резекции. Поиск работ осуществляли по ключевым словам на английском языке, использовали платформу PubMed. Всего найдено 127 публикаций, в обзор включено 29. Рассмотрены эпидемиология, классификация ранних билиарных осложнений панкреатодуоденальной резекции, современные взгляды на патогенез, профилактические мероприятия, лечебно-диагностическая тактика. В раннем послеоперационном периоде возможны транзиторная желтуха, холангит, ранние стриктуры и несостоятельность гепатикоеюноанастомоза. Частота их варьирует от 3 до 24% и зависит от эпидемиологических особенностей популяции, особенностей статистического учета и сочетанных состояний. Описан ряд пациент-зависимых факторов риска, а также факторы, обусловленные хирургическими аспектами. Предложен целый ряд эффективных процедур для диагностики и устранения ранних билиарных осложнений, которые можно безопасно применять при ограниченных возможностях эндоскопических манипуляций и ревизионных вмешательств. Своевременная диагностика и лечение позволяют избежать тяжелого течения ранних билиарных осложнений и повторных вмешательств, сохранять медицинские и финансовые ресурсы и обеспечивать благоприятный прогноз.

Ключевые слова:
поджелудочнаяжелеза, панкреатодуоденальная резекция, былыарные осложненыя, былыодыгестывный анастомоз, несостоятельность, билиарная фистула, холангит, билиарная стриктура, pancreas, pancreatoduodenectomy, early biliary complications, anastomoses leakage, postoperative biliary fistula, cholangitis, early biliary structures

Литература:
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Early biliary complications after pancreatoduodenectomy

This study aimed to review latest investigations concerning early biliary complications following major pancreatic surgery. 127 original articles in English language were found via PubMed literature search using key words over the last 5 years. After application of exclusion criteria (full-text in English not available, duplicating paper, age of paper over 5 years) a total of 29 articles were included in this study. Herein we review epidemiology and classification of early biliary complications after pancreatoduodenectomy, current views on pathogenesis, prophylaxis, diagnostics and treatment of early biliary complications. In early postoperative course of pancreatoduodenectomy patients may develop transient jaundice, cholangitis, early biliary strictures and post-procedural bile leak. Frequency of these conditions range from 3 to 24% and depends on epidemiological features of population, statistics and combined conditions. A number of patient- and surgery-dependent risk factors have been described. Modern interventional radiology offers a wide range of procedures for diagnostics and treatment of early biliary complications after pancreatoduodenectomy which showed to be safe and effective when endoscopic manipulations are contraindicated due to high risk. Well-timed diagnosis and treatment allow to avoid severe early biliary complications, re-interventions and reoperations which provides a good prognosis and lowers medical and financial burden.

Keywords:
поджелудочнаяжелеза, панкреатодуоденальная резекция, былыарные осложненыя, былыодыгестывный анастомоз, несостоятельность, билиарная фистула, холангит, билиарная стриктура, pancreas, pancreatoduodenectomy, early biliary complications, anastomoses leakage, postoperative biliary fistula, cholangitis, early biliary structures