Effectiveness of a new approach to minimally invasive surgery in palliative treatment of patients with distal malignant biliary obstruction  

作　　者：Yaroslav M Susak Leonid L Markulan Serhii M Lobanov Roman Y Palitsya Mariia P Rudyk Larysa M Skivka 

机构地区：[1]Department of Surgery with the Course of Emergency and Vascular Surgery,O.O.Bogomolets National Medical University,Kyiv 01601,Ukraine [2]Department of Abdominal Surgery,National Military Medical Clinical Centre“Main Military Clinical Hospital”,Kyiv 01133,Ukraine [3]Department of Microbiology and Immunology,Taras Shevchenko National University of Kyiv,Kyiv 01033,Ukraine

出　　处：《World Journal of Gastrointestinal Surgery》2023年第4期698-711,共14页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Palliative endoscopic biliary drainage is the primary treatment option for the management of patients with jaundice which results from distal malignant biliary obstruction(DMBO).In this group of patients,decompression of the bile duct(BD)allows for pain reduction,symptom relief,chemotherapy administration,improved quality of life,and increased survival rate.To reduce the unfavorable effects of BD decompression,minimally invasive surgical techniques require continuous improvement.AIM To develop a technique for internal-external biliary-jejunal drainage(IEBJD)and assess its effectiveness in comparison to other minimally invasive procedures in the palliative treatment of patients with DMBO.METHODS A retrospective analysis of prospectively collected data was performed,which included 134 patients with DMBO who underwent palliative BD decompression.Biliary-jejunal drainage was developed to divert bile from the BD directly into the initial loops of the small intestine to prevent duodeno-biliary reflux.IEBJD was carried out using percutaneous transhepatic access.Percutaneous transhepatic biliary drainage(PTBD),endoscopic retrograde biliary stenting(ERBS),and internal-external transpapillary biliary drainage (IETBD) were used for the treatment of studypatients. Endpoints of the study were the clinical success of the procedure, the frequency andnature of complications, and the cumulative survival rate.RESULTSThere were no significant differences in the frequency of minor complications between the studygroups. Significant complications occurred in 5 (17.2%) patients in the IEBJD group, in 16 (64.0%)in the ERBS group, in 9 (47.4%) in the IETBD group, and in 12 (17.4%) in the PTBD group.Cholangitis was the most common severe complication. In the IEBJD group, the course ofcholangitis was characterized by a delayed onset and shorter duration as compared to other studygroups. The cumulative survival rate of patients who underwent IEBJD was 2.6 times higher incomparison to those of the PTBD and IETBD groups and 20% hig

关 键 词：Distal malignant biliary obstruction Obstructive jaundice Bile duct decompression Palliative endoscopic biliary drainage Internal-external biliary-jejunal drainage 

分 类 号：R735.8[医药卫生—肿瘤]