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Спорные вопросы билиарной декомпрессии при механической желтухе опухолевого генеза

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В настоящее время стратегия предоперационного лечения пациентов с механической желтухой опухолевого генеза не определена. Продолжаются дискуссии о показаниях к желчеотведению, выборе метода билиарного дренирования и его продолжительности. Анализ международных исследований показал, что рутинное предоперационное дренирование “по умолчанию” не рекомендовано. Показания к билиарному дренированию при резектабельном процессе определяют по тяжести механической желтухи, холангиту, срокам предстоящей операции, а при проксимальном уровне билиарного блока - по типу опухоли по Bismuth-Corlette. Выбор антеградного или ретроградного способа предоперационного желчеотведения зависит от уровня билиарного блока и возможностей лечебного учреждения. В большинстве исследований показано, что предпочтительными являются ретроградные (эндоскопические) способы при дистальном блоке и антеградные (чреспеченочные) - при проксимальном. Сроки предоперационного дренирования зависят от нормализации показателей биохимического анализа крови. Увеличение продолжительности дренирования может способствовать развитию ранних послеоперационных осложнений. Оптимальным сроком считают 2 нед. Для успешного лечения больных механической желтухой опухолевого генеза необходимо максимально достоверно определить причину ее развития, что позволяет выработать стратегию и тактику в конкретной клинической ситуации. Целесообразность и способ билиарной декомпрессии следует рассматривать в соответствии с выбранной стратегией лечения пациента.

Ключевые слова:
печень, желчные протоки, механическая желтуха, антеградное дренирование, ретроградное дренирование, билиарная декомпрессия, liver, bile ducts, obstructive jaundice, antegrade drainage, retrograde drainage, biliary decompression

Литература:
1.Kruse E.J. Palliation in pancreatic cancer. Surg. Clin. North Am. 2010; 90 (2): 355-364. http://doi.org/10.1016/j.suc.2009.12.004
2.Leng J.J., Zhang N., Dong J.H. Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis. World J. Surg. Oncol. 2014; 12 (1): 272. http://doi.org/10.1186/1477-7819-12-272
3.Gillen S., Schuster T., Meyer Zum, Buschenfelde C., Friess H., Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010; 7 (4): e1000267. http://doi.org/10.1371/journal.pmed.1000267
4.Руководство по хирургии желчных путей. Изд. 2-е. Под ред. Гальперина Э.И., Ветшева П.С. М.: Видар, 2009. С. 284-287.
5.Подолужный В.И. Механическая желтуха: принципы диагностики и современного хирургического лечения. Фундаментальная и клиническая медицина. 2018; 3 (2): 82-92.
6.Yoon W.J., Lee J.K., Lee K.H., Lee W.J., Ryu J.K., Kim Y.T., Yoon Y.B. A comparison of covered and uncovered wall stents for the management of distal malignant biliary obstruction. Gastrointest. Endosc. 2006; 63 (7): 996-1000.
7.Ferrero A., Lo Tesoriere R., Vigano L., Caggiano L., Sgotto E., Capussotti L. Preoperative biliary drainage increases infectious complications after hepatectomy for proximal bile duct tumor obstruction. World J. Surg. 2009; 33 (2): 318-325.
8.Papadopoulos V., Filippou D., Manolis E., Mimidis K. Haemostasis impairment in patients with obstructive jaundice. J. Gastrointestin. Liver Dis. 2007; 16 (2): 177-186.
9.Nimura Y. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro). HPB (Oxford). 2008; 10 (2): 130-133. http://doi.org/10.1080/13651820801992666
10.Iacono C., Ruzzenente A., Campagnaro T., Bortolasi L., Valdegamberi A., Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepaticresection: highlights and drawbacks. Ann. Surg. 2013; 257 (2): 191-204. http://doi.org/10.1097/SLA.0b013e31826f4b0e
11.Strasberg S.M., Gao F., Sanford D., Linehan D.C., Hawkins W.G., Fields R., Carpenter D.H., Brunt E.M., Phillips C. Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas. HPB (Oxford). 2014; 16 (2): 150-156. http://doi.org/10.1111/hpb.12094
12.Гальперин Э.И. Классификация тяжести механической желтухи. Анналы хирургической гепатологии. 2012; 17 (2): 26-33.
13.Sauvanet A., Boher J.M., Paye F., Bachellier P., Sa Cuhna A., Le Treut Y.P., Adham M., Mabrut J.Y., Chiche L., Delpero J.R. Severe jaundice increases early severe morbidity and decreases long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. J. Am. Coll. Surg. 2015; 221 (2): 380-389. http://doi.org/10.1016/j.jamcollsurg.2015.03.058
14.van der Gaag N.A., Rauws E.A., van Eijck C.H., Bruno M.J., van der Harst E., Kubben F.J., Gerritsen J.J., Greve J.W., Gerhards M.F., de Hingh I.H., Klinkenbijl J.H., Nio C.Y., de Castro S.M., Busch O.R., van Gulik T.M., Bossuyt P.M., Gouma D.J. Preoperative biliary drainage for cancer of the head of the pancreas. N. Engl. J. Med. 2010; 362 (2): 129-137. http://doi.org/10.1056/NEJMoa0903230
15.Nuzzo G., Giuliante F., Ardito F., Giovannini I., Aldrighetti L., Belli G., Bresadola F., Calise F., Dalla Valle R., D''Amico D.F., Gennari L., Giulini S.M., Guglielmi A., Jovine E., Pellicci R., Pernthaler H., Pinna A.D., Puleo S., Torzilli G., Capussotti L., Cillo U., Ercolani G., Ferrucci M., Mastrangelo L., Portolani N., Pulitano C., Ribero D., Ruzzenente A., Scuderi V., Federico B. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch. Surg. 2012; 147 (1): 26-34. http://doi.org/10.1001/archsurg.2011.771
16.Gouma D.J. Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br. J. Surg. 2013; 100 (2): 283-284. http://doi.org/10.1002/bjs.8977
17.Makuuchi M., Thai B.L., Takayasu K., Takayama T., Kosuge T., Gunven P., Yamazaki S., Hasegawa H., Ozaki H. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990; 107 (2): 521-527.
18.Nimura Y., Hayakawa N., Kamiya J., Kondo S., Shionoya S. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J. Surg. 1990; 14 (4): 535-543; discussion 544.
19.Su C.H., Tsay S.H., Wu C.C., Shyr Y.M., King K.L., Lee C.H., Lui W.Y., Liu T.J., P''eng F.K. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann. Surg. 1996; 223 (4): 384-394.
20.Cho M.S., Kim S.H., Park S.W., Lim J.H., Choi G.H., Park J.S., Chung J.B., Kim K.S. Surgical outcomes and predicting factors of curative resection in patients with hilar cholangiocarcinoma: 10-year single-institution experience. J. Gastrointest. Surg. 2012; 16 (9): 1672-1679. http://doi.org/10.1007/s11605-012-1960-0.
21.Tang Z., Yang Y., Meng W., Li X. Best option for preoperative biliary drainage in Klatskin tumor: a systematic review and metaanalysis. Medicine (Baltimore). 2017; 96 (43): 8372.
22.Higuchi R., Yamamoto M. Indications for portal vein embolization in perihilar cholangiocarcinoma. J. Hepatobiliary Pancreat. Sci. 2014; 21 (8): 542-549. http://doi.org/10.1002/jhbp.77
23.Wiggers J.K., Groot Koerkamp B., Cieslak K.P., Doussot A., van Klaveren D., Allen P.J., Besselink M.G., Busch O.R., D''Angelica M.I., DeMatteo R.P., Gouma D.J., Kingham T.P., van Gulik T.M., Jarnagin W.R. Postoperative mortality after liver resection for perihilar cholangiocarcinoma: development of a risk score and importance of biliary drainage of the future liver remnant. J. Am. Coll. Surg. 2016; 223 (2): 321-331. http://doi.org/10.1016/j.jamcollsurg.2016.03.035
24.Mansour J.C., Aloia T.A., Crane C.H., Heimbach J.K., Nagino M., Vauthey J.N. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford). 2015; 17 (8): 691-699. http://doi.org/10.1111/hpb.12450
25.Hochwald S.N., Burke E.C., Jarnagin W.R., Fong Y., Blumgart L.H. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch. Surg. 1999; 134 (3): 261-266.
26.Herzog T., Belyaev O., Hessam S., Suelberg D., Janot M., Schrader H., Schmidt W.E., Anders A., Uhl W., Mueller C.A. Bacteribilia with resistant microorganisms after preoperative biliary drainage - the influence of bacteria on postoperative outcome. Scand. J. Gastroenterol. 2012; 47 (7): 827-835. http://doi.org/10.3109/00365521.2012.679684
27.Scheufele F., Schorn S., Demir I.E., Sargut M., Tieftrunk E., Calavrezos L., Jager C., Friess H., Ceyhan G.O. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature. Surgery. 2017; 161 (4): 939-950. http://doi.org/10.1016/j.surg.2016.11.001
28.Sakata J., Shirai Y., Tsuchiya Y., Wakai T., Nomura T., Hatakeyama K. Preoperative cholangitis independently increases in-hospital mortality after combined major hepatic and bile duct resection for hilar cholangiocarcinoma. Langenbecks Arch. Surg. 2009; 394 (6): 1065-1072. http://doi.org/10.1007/s00423-009-0464-1
29.Nagino M., Ebata T., Yokoyama Y., Igami T., Sugawara G., Takahashi Y., Nimura Y. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann. Surg. 2013; 258 (1): 129-140. http://doi.org/10.1097/SLA.0b013e3182708b57
30.Yokoyama Y., Ebata T., Igami T., Sugawara G., Mizuno T., Nagino M. The adverse effects of preoperative cholangitis on the outcome of portal vein embolization and subsequent major hepatectomies. Surgery. 2014; 156 (5): 1190-1196. http://doi.org/10.1016/j.surg.2014.04.036
31.Wiggers J.K., Coelen R.J., Rauws E.A., van Delden O.M., van Eijck C.H., de Jonge J., Porte R.J., Buis C.I., Dejong C.H., Molenaar I.Q., Besselink M.G., Busch O.R., Dijkgraaf M.G., van Gulik T.M. Preoperative endoscopic versus percutaneous transhepatic biliary drainage in potentially resectable perihilar cholangiocarcinoma (DRAINAGE trial): design and rationale of a randomized controlled trial. BMC Gastroenterol. 2015; 15: 20. http://doi.org/10.1186/s12876-015-0251-0
32.Ribero D., Zimmitti G., Aloia T.A., Shindoh J., Fabio F., Amisano M., Passot G., Ferrero A., Vauthey J.N. Preoperative cholangitis and future liver remnant volume determine the risk of liver failure in patients undergoing resection for hilar cholangiocarcinoma. J. Am. Coll. Surg. 2016; 223 (1): 87-97. http://doi.org/10.1016/j.jamcollsurg.2016.01.060
33.Wang Y., Fu W., Tang Z., Meng W., Zhou W., Li X. Effect of preoperative cholangitis on prognosis of patients with hilar cholangiocarcinoma. A systematic review and meta-analysis. Medicine (Baltimore). 2018; 97 (34): e12025. http://doi.org/10.1097/MD.0000000000012025
34.Liu F., Li Y., Wei Y., Li B. Preoperative biliary drainage before resection for hilar cholangiocarcinoma: whether or not? A systematic review. Dig. Dis. Sci. 2011; 56 (3): 663-672. http://doi.org/10.1007/s10620-010-1338-7
35.Celotti A., Solaini L., Montori G., Coccolini F., Tognali D., Baiocchi G. Preoperative biliary drainage in hilar cholangiocarcinoma: Systematic review and meta-analysis. Eur. J. Surg. Oncol. 2017; 43 (9): 1628-1635. http://doi.org/10.1016/j.ejso.2017.04.001
36.Wiggers J.K., Groot Koerkamp B., Cieslak K.P., Doussot A., Allen P.J., Besselink M.G., Busch O.R., D''Angelica M.I., DeMatteo R.P., Gouma D.J., Kingham T.P., van Gulik T.M., Jarnagin W.R. Development of a preoperative risk score for postoperative mortality after liver resection for presumed perihilar cholangiocarcinoma. HPB. 2016; 18 (2): e863-e864. http://doi.org/10.1016/j.hpb.2016.01.491
37.Farges O., Regimbeau J.M., Fuks D., Le Treut Y.P., Cherqui D., Bachellier P., Mabrut J.Y., Adham M., Pruvot F.R., Gigot J.F. Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br. J. Surg. 2013; 100 (2): 274-283. http://doi.org/10.1002/bjs.8950
38.Paik W.H., Loganathan N., Hwang J.H. Preoperative biliary drainage in hilar cholangiocarcinoma: when and how? World J. Gastrointest. Endosc. 2014; 6 (3): 68-73. http://doi.org/10.4253/wjge.v6.i3.68
39.Pancreatic Adenocarcinoma. NCCN Clinical Practice Guidelines in Oncology Version 2. 2015. National Comprehensive Cancer Network www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf.
40.Nagino M., Takada T., Miyazaki M., Miyakawa S., Tsukada K., Kondo S., Furuse J., Saito H., Tsuyuguchi T., Yoshikawa T., Ohta T., Kimura F., Ohta T., Yoshitomi H., Nozawa S., Yoshida M., Wada K., Amano H., Miura F. Preoperative biliary drainage for biliary tract and ampullary carcinoma. J. HPB Surg. 2008; 15 (1): 25-30. http://doi.org/10.1007/s00534-007-1277-7
41.Sasahira N., Hamada T., Togawa O., Yamamoto R., Iwai T., Tamada K., Kawaguchi Y., Shimura K., Koike T., Yoshida Y., Sugimori K., Ryozawa S., Kakimoto T., Nishikawa K., Kitamura K., Imamura T., Mizuide M., Toda N., Maetani I., Sakai Y., Itoi T., Nagahama M., Nakai Y., Isayama H. Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction. World J. Gastroenterol. 2016; 22 (14): 3793-3802. http://doi.org/10.3748/wjg.v22.i14.3793
42.Crippa S., Cirocchi R., Partelli S., Petrone M.C., Muffatti F., Renzi C., Falconi M., Arcidiacono P.G. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur. J. Surg. Oncol. 2016; 42 (9): 1278-1280. http://doi.org/10.1016/j.ejso.2016.05.001
43.Tol J.A.M., van Hooft J.E., Timmer R., Kubben F.J., van der Harst E., de Hingh I.H., Vleggaar F.P., Molenaar I.Q., Keulemans Y.C., Boerma D., Bruno M.J., Schoon E.J., van der Gaag N.A., Besselink M.G., Fockens P., van Gulik T.M., Rauws E.A., Busch O.R., Gouma D.J. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut. 2016; 65 (12): 1981-1987. http://doi.org/10.1136/gutjnl-2014-308762
44.Lin H., Li S., Liu X. The safety and efficacy of nasobiliary drainage versus biliary stenting in malignant biliary obstruction. A systematic review and meta-analysis. Medicine (Baltimore). 2016; 95 (46): e5253. http://doi.org/10.1097/MD.0000000000005253
45.Hong S.K., Jang J.-Y., Kang M.J., Han I.W., Kim S.W. Comparison of clinical outcome and cost-effectiveness after various preoperative biliary drainage methods in periampullary cancer with obstructive jaundice. J. Korean Med. Sci. 2012; 27 (4): 356-362. http://doi.org/10.3346/jkms.2012.27.4.356
46.Inamdar S., Slattery E., Bhalla R., Sejpal D.V., Trindade A.J. Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort. JAMA Oncol. 2016; 2 (1): 112-117. http://doi.org/10.1001/jamaoncol.2015.3670
47.Wagner A., Mayr C., Kiesslich T., Berr F., Friesenbichler P., Wolkersdorfer G.W. Reduced complication rates of percutaneous transhepatic biliary drainage with ultrasound guidance. J. Clin. Ultrasound. 2017; 45 (7): 400-407. http://doi.org/10.1002/jcu.22461
48.Сancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2015; 26 (5): 56-68.
49.Speer A.G., Cotton P.B., Russell R.C., Mason R.R., Hatfield A.R., Leung J.W., MacRae K.D., Houghton J., Lennon C.A. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987; 2 (8550): 57-62.
50.Hameed A., Pang T., Chiou J., Pleass H., Lam V., Hollands M., Johnston E., Richardson A., Yuen L. Percutaneous vs. endoscopic preoperative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis. HPB (Oxford). 2016; 18 (5): 400-410. http://doi.org/10.1016/j.hpb.2016.03.002
51.Al Mahjoub A., Menahem B., Fohlen A., Dupont B., Alves A., Launoy G., Lubrano J. Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J. Vasc. Intervent. Radiol. 2017; 28 (4): 576-582. http://doi.org/10.1016/j.jvir.2016.12.1218
52.Liu J.G., Wu J., Wang J., Shu G.M., Wang Y.J., Lou C., Zhang J., Du Z. Endoscopic biliary drainage versus percutaneous transhepatic biliary drainage in patients with resectable hilar cholangiocarcinoma: a systematic review and meta-analysis. J. Laparoendosc. Adv. Surg. Tech. A. 2018; 28 (9): 1053-1060. http://doi.org/10.1089/lap.2017.0744
53.Tang Z., Yang Y., Meng W., Li X. Best option for preoperative biliary drainage in Klatskin tumor: a systematic review and metaanalysis . Medicine (Baltimore). 2017; 96 (43): e8372. http://doi.org/10.1097/MD.0000000000008372
54.Кулезнева Ю.В., Мелехина О.В., Курмансуитова Л.И., Ефанов М.Г., Цвиркун В.В., Огнева А.Ю., Мусатов А.Б., Патрушев И.В. Антеградное желчеотведение: анализ осложнений и способы их профилактики. Анналы хирургической гепатологии. 2018; 23 (3): 37-46. http://doi.org/10.16931/1995-5464.2018337-46
55.Yamashita H., Ebata T., Yokoyama Y., Igami T., Mizuno T., Yamaguchi J., Onoe S., Watanabe N., Ando M., Nagino M. Pleural dissemination of cholangiocarcinoma caused by percutaneous transhepatic biliary drainage during the management of resectable cholangiocarcinoma. Surgery. 2018; pii: S0039-6060 (18)30727-X. http://doi.org/10.1016/j.surg.2018.10.015
56.Nagino M., Ebata T., Yokoyama Y., Igami T., Sugawara G., Takahashi Y., Nimura Y. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann. Surg. 2013; 258 (1): 129-140. http://doi.org/10.1097/SLA.0b013e3182708b57
57.Zhang X.F., Beal E.W., Merath K., Ethun C.G., Salem A., Weber S.M., Tran T., Poultsides G., Son A.Y., Hatzaras I., Jin L., Fields R.C., Weiss M., Scoggins C., Martin R.C.G., Isom C.A., Idrees K., Mogal H.D., Shen P., Maithel S.K., Schmidt C.R., Pawlik T.M. Oncologic effects of preoperative biliary drainage in resectable hilar cholangiocarcinoma: Percutaneous biliary drainage has no adverse effects on survival. J. Surg. Oncol. 2018; 117 (6): 1267-1277. http://doi.org/10.1002/jso.24945
58.Wiggers J.K., Groot Koerkamp B., Coelen R.J., Doussot A., van Dieren S., Rauws E.A., Schattner M.A., van Lienden K.P., Brown K.T., Besselink M.G., van Tienhoven G., Allen P.J., Busch O.R., D''Angelica M.I., DeMatteo R.P., Gouma D.J., ingham T.P., Verheij J., Jarnagin W.R., van Gulik T.M. Percutaneous preoperative biliary drainage for resectable perihilar cholangiocarcinoma: no association with survival and no increase in seeding metastases. Ann. Surg. Oncol. 2015; 22 (3): 1156-S1163. http://doi.org/10.1245/s10434-015-4676-z
59.Figueras J., Llado L., Valls C., Serrano T., Ramos E., Fabregat J., Rafecas A., Torras J., Jaurrieta E. Changing strategies in diag nosis and management of hilar cholangiocarcinoma. Liver Transpl. 2000; 6 (6): 786-794. http://doi.org/10.1053/jlts.2000.18507
60.Sewnath M.E., Karsten T.M., Prins M.H., Rauws E.J., Obertop H., Gouma D.J. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann. Surg. 2002; 236 (1): 17-27.
61.Pisters P.W., Hudec W.A., Hess K.R., Lee J.E., Vauthey J.N., Lahoti S., Raijman I., Evans D.B. Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann. Surg. 2001; 234 (1): 47-55.
62.Watanapa P. Recovery patterns of liver function after complete and partial surgical biliary decompression. Am. J. Surg. 1996; 171 (2): 230-234. http://doi.org/10.1016/S0002-9610(97)89554-2
63.Sewnath M.E., Birjmohun R.S., Rauws E.A., Huibregtse K., Obertop H., Gouma D.J. The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. J. Am. Coll. Surg. 2001; 192 (6): 726-734. PMID: 11400966
64.van der Gaag N.A., Rauws E.A., van Eijck C.H., Bruno M.J., van der Harst E., Kubben F.J., Gerritsen J.J., Greve J.W., Gerhards M.F., de Hingh I.H., Klinkenbijl J.H., Nio C.Y., de Castro S.M., Busch O.R., van Gulik T.M., Bossuyt P.M., Gouma D.J. Preoperative biliary drainage for cancer of the head of the pancreas. N. Engl. J. Med. 2010; 362 (2): 129-137. http://doi.org/10.1056/NEJMoa0903230
65.Karsten T.M., Coene P.P., van Gulik T.M., Bosma A., van Marle J., James J., Lygidakis N.J., Klopper P.J., van der Heyde M.N. Morphologic changes of extrahepatic bile ducts during obstruction and subsequent decompression by endoprosthesis. Surgery. 1992; 111 (5): 562-568. PMID: 1598676
66.Son J.H., Kim J., Lee S.H., Hwang J.H., Ryu J.K., Kim Y.T., Yoon Y.B., Jang J.Y., Kim S.W., Cho J.Y. The optimal duration of preoperative biliary drainage for periampullary tumors that cause severe obstructive jaundice. Am. J. Surg. 2013; 206: 40-46. http://doi.org/10.1016/j.amjsurg.2012.07.047

Disputable issues of biliary drainage procedures in malignant obstructive jaundice

Currently, the strategy for preoperative management of patients with malignant obstructive jaundice is not defined. The indications for biliary drainage procedures, the choice of biliary drainage technique and duration of preoperative drainage are still disputable. Analysis of international trials revealed that routine preoperative biliary drainage procedures are not recommended. The indications for biliary drainage in resectable tumors are determined considering severity of obstructive jaundice, cholangitis, dates of major surgery and Bismuth-Corlette tumor type in case of proximal biliary stricture. The choice of retrograde or antegrade preoperative biliary drainage depends on the type of biliary stricture (distal or proximal) and possibilities of medical institution. The majority of studies showed that retrograde (endoscopic) biliary drainage procedures are preferred for distal strictures, antegrade (transhepatic) - for proximal ones. Duration of preoperative biliary drainage depends on normalization of biochemical values. Prolonged drainage may be followed by increased incidence of early postoperative complications. The optimal period of preoperative biliary drainage is 2 weeks. It is necessary to determine the causes of obstructive jaundice as early as possible for successful treatment. This is also essential to define optimal treatment strategy in certain case. Advisability and certain technique of biliary decompression should be determined in accordance with the chosen treatment strategy.

Keywords:
печень, желчные протоки, механическая желтуха, антеградное дренирование, ретроградное дренирование, билиарная декомпрессия, liver, bile ducts, obstructive jaundice, antegrade drainage, retrograde drainage, biliary decompression