Гострий канцероматозний панкреатит у хворих на рак головки підшлункової залози, ускладнений механічною жовтяницею

Abstract

Aim of study — improve the diagnosis and results of palliative surgical treatment of patients with unresectable of the pancreas head cancer, complicated by mechanical jaundice, in cases of pancreatic carcer. Materials and methods. A comparative analysis of the results of the application of various surgical techniques in the palliative surgical treatment of patients of the two groups was conducted on unresectable pancreatic head cancer enclosed with mechanical jaundice, aimed at correcting the bile duct obstruction syndrome by means of biliodygistive bypass grafting. At the first stage of the study, an analysis of the archival material was performed (1 group of patients, 155 persons) and it was established that although the tumour of the pancreas causes obstruction of both the common bile duct and the main pancreatic duct, however, mechanical jaundice was developed in all patients, and obstructive pancreatic carcinoma pancreatitis only in 8.8 % of patients. The mild forms of such pancreatitis were effectively eliminated by known methods of intensive care. However, in cases of development of pancreatitis of moderate severity (according to the Atlanta-92 classification, third revision), the state of patients’ health progressively deteriorated, as the background of mechanical jaundice developed a multiorgan disfunctional life of the body’s protective systems and the performance of biliodigestive bypassing was not in all cases sufficient to avoid a number postoperative complications and unsatisfactory results. After analysing the obtained results, it was concluded that modernization is subject to both tactics and techniques of surgical treatment of such patients. Therefore, it was planned and carried out own research with the purpose of approbation of the formulated technology of treatment of such patients. To this end, 112 patients with cancer of the pancreas head, complicated by mechanical jaundice (Group II), were treated in the clinic of the department and in the surgical clinic of the National Military Medical Clinical Center for the period of 2007 — 2018 in an open, prospective, randomized study. and who was undergoing palliative surgical treatment. In the surgical treatment of these patients, an approbation of the developed algorithm for the verification of carcinomatous pancreatitis was performed; the evaluation of the effectiveness of the proposed tactics and the technique of surgical treatment of patients, including the developed method of combined bilio- and pancreaticodigestive bypass surgery. A comparative analysis of the results of surgical treatment of patients of both subgroups was conducted. Conclusions The proposed tactics of two-stage surgical treatment of patients with nonresectable cancer of the pancreas head complicated by mechanical jaundice and pancreatic cancer, which includes a two stage technology of surgical interventions with the use of minimally invasive operations in the first stage of treatment and one-step combined bilio- and pancreaticodigestive bypass surgery on the second one, contributes to the reduction of postoperative complications, mortality and improves the quality of life of patients.