Abstract: Aim: was to improve the efficiency of external drainage in patients with biliary tree obstruction by tumor process in the porta hepatis zone. Materials and methods: percutaneous transhepatic cholangiostomy under the combined sonofluoroscopic control with using on the first phase of the treatment of self-locking drainages pig tail №8Fr followed by external-internal drainage or endobiliary stenting were performed in 147 patients with «high» tumor block of the biliary tree. Results: depending on the extent of biliary occlusion there were from 1 to 6 drainages. «Big» post-manipulating complication encountered in one patient (0.7%) - migration of cholangiostomic drainage with the development of biliary peritonitis. «Small» complications (short-period haemobilia, migration of cholangiostomy amilazemiya at transpapillary insertion of an external-internal drainage) occurred in 20 patients (13.6%). Mortality rate was 6.1%. Death causes: common bile peritonitis (1 case), and the progression of hepatorenal insufficiency on the background of biliary decompression (8 cases). Conclusion: antegrade cholangiostomy at «high» tumor obstruction of the biliary tree is a necessary manipulation as in palliative biliary decompression, and in the preparation of the patient for radical surgery for Klatskin tumors. Satisfactory performance of postmanipulating complications and in-hospital mortality involve the use of special techniques for effective external and external-internal drainage of bile ducts. References 1. Witzigmann H., Lang H., Lauer H. Guidelines for palliative surgery of cholangiocarcinoma HPB (Oxford). Jun 1, 2008; 10(3): 154-160. doi: 10.1080/13651820801992567 PMCID: PMC2504365. 2. Rerknimitr R., Kullavanijaya P. Operable malignant jaundice: To stent or not to stent before the operation? World J. Gastrointest. Endosc. 2010 Jan 16;2(1):10-4. doi: 10.4253/wjge.v2.i1.10. 3. Paik W.H., Loganathan N., Hwang J.H. Preoperative biliary drainage in hilar cholangiocarcinoma: When and how? World J. Gastrointest. Endosc. 2014 Mar 16;6(3):68-73. doi: 10.4253/wjge.v6.i3.68. Review. 4. 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 Mar; 56(3):663-72. doi: 10.1007/s10620-010-1338-7. Epub 2010 Jul 16. 5. Kawakami H., Kondo S., Kuwatani M., Yamato H., Ehira N., Kudo T., Eto K., Haba S., Matsumoto J., Kato K., Tsuchikawa T., Tanaka E., Hirano S., Asaka M. Preoperative biliary drainage for hilar cholangiocarcinoma: which stent should be selected? J. Hepatobiliary Pancreat Sci. 2011 Sep; 18 (5):630-5. doi: 10.1007/s00534-011- 0404-7. 6. Ustunda Y, Boyvat F. Debate continues over which method we should prefer for the preoperative biliary decompression in cases with hilar cholangiocarcinoma. J. Gastroenterol. 2012 Jan; 47(1):88-9; author reply 90-1. doi: 10.1007/s00535-011-0496-5. Epub 2011 Nov 15. 7. 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., Improvement in perioperative and longterm outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian
Dissociation of clinical-laboratory and instrumental manifestations of cholestasis in patient after resection of liver in case of portal cholangiocarcinoma and polychemotherapy. dangers of its x-ray-surgical resolution (case report)
DOI: https://doi.org/10.25512/DIR.2016.10.4.07
For quoting:
Okhotnikov O.I., Yakovleva M.V. "Dissociation of clinical-laboratory and instrumental manifestations of cholestasis in patient after resection of liver in case of portal cholangiocarcinoma and polychemotherapy. dangers of its x-ray-surgical resolution (case report)". Journal Diagnostic & interventional radiology. 2016; 10(4); 57-61.
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Abstract: Article describes the experience of X-ray-surgical treatment of patient with clinical and laboratory manifestations of cholestasis without a concomitant expansion of bile ducts. In anamnesis of disease - left-sided hemihepatectomy, hepaticojejunostomy on wireframe transhepatic drainage for treatment of portal cholangiocarcinoma III-b, 6 courses of adjuvant chemotherapy. Frame-drainage was removed after 6.5 months after surgery and 2 weeks before this hospitalization. Bilirubinemia (bilirubin 394.89 (233,00-161,89) mol/L) with signs dysproteinemia, cytolysis and anticoagulation were marked during the hospitalization. Lack of pneumobilia during sonography suggested that the most likely cause of cholestasis is a violation of the biliodigestive anastomosis patency Antegrade biliary decompression led to the development of hepatic failure, which was successfully treated by syndromic intensive therapy Following antegrade balloon dilatation of biliodigestive anastomosis area with its external-internal frame-drainage let us to eliminate clinical and laboratory manifestations of obstructive jaundice. Conclusion: the need for a surgical biliary decompression in cancer patients with cholestasis without a significant expansion of bile ducts with a decrease of functional reserves of the liver is accompanied by the risk of development or progression of liver failure, which leads to complexity and ambiguity of the choice of treatment strategy in these patients. References 1. Yurchenko V.V. Javljaetsja li suprastenoticheskaja dilatacija objazatel'nym simptomom narushenija ottoka zhelchi? [Is suprastenotic dilatation a mandatory symptom of impaired bile outflow?] Vestnik rentgenologii i radiologii. 2015; 3: 18-22. [In Russ].
