Технологія паліативного хірургічного лікування хворих на нерезектабельний рак головки підшлункової залози, ускладнений механічною жовтяницею

Abstract

Relevance. It is relevant to develop new technological solutions for palliative surgical treatment of patients with unresectable pancreatic head cancer (UPHC), since the incidence of postoperative complications in such patients reaches 25%, and mortality – 20%. Objective. To improve the diagnosis and immediate results of palliative surgical treatment of patients with UPHC complicated by obstructive jaundice, duodenal obstruction, and carcinomatous pancreatitis. Materials and methods. At the first stage of the study, criteria for the diagnosis of PHC complications, tactics and methods for their surgical correction were evaluated (group I, 159 patients). After analyzing the results, a new technology for the surgical treatment of patients is formulated, the clinical testing of which was carried out in the second stage. An open, prospective, randomized study included 112 patients with UPHC complicated by obstructive jaundice (group II), who underwent palliative surgical treatment using patented surgical procedures. A comparative analysis of the results of surgical treatment of patients of both groups was carried out. Results. The safety and effectiveness of the simultaneous implementation with biliodigestive gastrodigestive shunting has been proven. The advantages of the tactics of two-stage surgical treatment of patients with signs of liver failure are shown. In patients with high anesthetic and surgical risk, the replacement of open surgery with endoscopic prosthetics of the biliary system and duodenal obstruction is justified. In severe forms of carcinomatous pancreatitis with expansion of the main pancreatic duct, a technique for combined bilio- and pancreatodigestive shunting is proposed. When multiple organ dysfunctions with hepatic-renal, hemorrhagic syndromes are formed in patients with obstructive jaundice, decompression of the biliary system by minimally invasive techniques is shown in the first stage, and the main stage of surgical intervention in the second. As a result, the incidence of postoperative complications was 9,8%, mortality – 3,7%. Conclusions. In patients with UPHC cancer complicated by obstructive jaundice, performing instead of traditional biliodigestive bypass surgery combined bilioastrodigestive bypass surgery is a safe procedure that does not increase the frequency of postoperative complications, prevents the need for repeated gastro-digestive interventions, improves the quality of life of patients in the long-term postoperative period. The operation of choice in the surgical treatment of patients with UPHC complicated by obstruction of the biliary system and duodenum with high surgical and anesthetic risk is endoscopic interventions with endoscopic prosthetics of the bile ducts and duodenum.