Selecnion of minimally invasive drainage interventions in patients with pancreatic head cancer
Kabanov M.1, Tarasov V.2, Solovjev I.3, Yakovleva D.4, BuninV. 5, Sementsov K. 6, Dimnikov D.7, Ambartsumyan S.8, Kraydenov A.9
Military Medical Academy1,2,3,5,6,7,8, Research Institute of Emergency Care4,9
According to diferent authors mortality from liver failure after operations performed against the backdrop of a long-term bile hypertension is 30%, which is largely due to a mismatch between the compensatory capacity of the liver and the severity of the surgery. This often dictates the need to perform the frst stage of biliary decompression to restore liver function and normalization of homeostasis. The selection of tactic of surgical intervention in patients with this pathology is an urgent problem because of the lack of clear criteria and treatment algorithms.
Objective. Improved results of treatment of patients with obstructive jaundice, justifying the optimal methods of minimally invasive interventions draining hepaticocholedochus depending on the motility of the gastrointestinal tract.
Material and methods. The basis of the clinical material were monitoring 116 (79 women, 37 men) patients with pancreatic head carcinoma, who were in treatment for jaundice of tumor genesis. The comparison group included 59 “apparently healthy“ volunteers aged 20–40 years.
A total of 87 percutaneous transhepaticholangiodrainage and 29 of the common bile duct stents, discharged 109 patients and died seven operated patients.
One method of diagnosing gastrointestinal myoelectric activity was gastroelectroentestinography.
This study we carried out in all patients with obstructive jaundice before and after surgery, using the Gastroskan. Also performed microbiological evaluation of intraoperative contamination diverted bile.
Evaluation of the efectiveness of treatment, we are done by Quality of Life Questionnaire SF-36 (Ware J.E., 1993) and OGPD (adapted questionnaire for patients with diseases hepatobilliaryduodenal zone, based on the questionnaire of quality of life (QOL) in patients with chronic pancreatitis (Bagnenko S., 1998).
Results. Investigating motor — evacuation function in patients with strictures hepaticocholedochus (study group) due to tumor lesions of the pancreatic head in the preoperative period, we identifed two types of motor activity: I — hypomotor (27.5%) and II — hypermotor (72.5%). The control group consisted of 59 “apparently healthy“ volunteers. Normal myoelectric activity of the gastrointestinal tract in these patients, we did not notice.
A number of patients undergoing external-internal drainage, marked deterioration caused not only the loss of bile, and intestinal contents at an average daily rate of up to 4–6 liters, and as a result difcult to compensate water and electrolyte disturbances. When study these patients revealed hypomotor type of the gastrointestinal tract. We have not seen these complications wiyh hypermotor type of gastrointestinal myoelectric activity.
In the analysis of long-term results of treatment after transhepatic cholan-gio drainage and biliary stenting, we found that the risk of rising cholangitis was 7 times higher in patients with type hypomotor activity gastrointestinal tract (29 vs. 4). In this group, the absence of microbial contamination of bile was observed only in 6%, and in patients with type hypermotor activity growth microorganisms were found in 91% of cases.
Investigation of quality of life in patients undergoing transhepatic cholangio drainage and stenting performed in the preoperative period, after 1 week from the moment of performance transhepatic cholangio drainage and 1 month. The study showed a statistically signifcant diference in performance. Quality of life in patients with type hypermotor activity is higher than hypomotor.
Thus, on the basis of these results, we concluded that the need to perform in patients with obstructive jaundice against cancer of the pancreatic head with hypomotor type myoelectric activity of the gastrointestinal tract only external drainage of the bile duct to prevent fuid and electrolyte disorders, and ascending cholangitis as a result, improve the quality of life.