肿瘤源性胆总管远端闭塞患者的胆道减压特点

M. Shevchuk, M. Dudchenko, M. Kravtsiv, D. Ivashchenko, R. A. Prykhidko, S. M. Zaiets
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引用次数: 0

摘要

我们对89例癌症肝-胰-十二指肠区并发机械性黄疸的检查和治疗进行了回顾性和前瞻性分析。发现胰头癌症69例,十二指肠大乳头癌症10例,肝外胆管癌症9例,十二指肠癌症1例。根据黄疸程度将所有患者分为3组。对86例患者进行了手术治疗。其中,13例在黄疸最严重时进行了手术,73例在之前的胆道系统微创减压后进行了手术。在17名(19.1%)患者中观察到术后并发症,其中12名(16.4%)患者在黄疸最严重时进行了手术,5名(6.8%)患者之前进行了胆道减压(第二阶段手术)。在6例严重黄疸患者中,在黄疸最严重的时候进行手术,即使在轻微的姑息手术后也会出现并发症。因此,在存在胆红素水平>200μmol/l的严重黄疸的情况下,应在胆管初步减压后分两个阶段进行根治性和姑息性手术。胆管减压可将术前时间缩短2-3周。
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FEATURES OF DECOMPRESSION OF THE BILIARY TRACT IN PATIENTS WITH OBTURATION OF THE DISTAL PART OF THE COMMON BILE DUCT OF TUMOR ORIGIN
We conducted a retrospective and prospective analysis of the examination and treatment of 89 patients with cancer of the hepato-pancreato-duodenal zone complicated by mechanical jaundice. Cancer of the head of the pancreas was found in 69 patients, cancer of the major duodenal papilla was detected in 10 patients, cancer of the extrahepatic bile ducts – in 9 patients, and cancer of the duodenum – in 1 case. All patients were divided into 3 groups depending on the degree of jaundice. Operative treatment was performed in 86 patients. Of them, 13 were operated on at the height of jaundice, and 73 – after previous minimally invasive decompression of the biliary system. Postoperative complications were observed in 17 (19.1%) patients, 12 (16.4%) of whom were operated on at the height of jaundice, and 5 (6.8%) – after previous biliary decompression (second-stage operations). In 6 patients with severe jaundice who were operated on at the height of jaundice, complications occurred even after minor palliative operations. Thus, in the presence of severe jaundice with bilirubin level > 200 μmol/l, radical and palliative operations should be performed only in two stages, after preliminary decompression of the bile ducts. Decompression of the bile ducts allows the reduction of the preoperative period by 2–3 weeks.
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