[Management of patients with malignant obstructive jaundice using bile examination after external biliary drainage]. / Lechenie bol'nykh mekhanicheskoi zheltukhoi zlokachestvennogo geneza na osnove rezul'tatov issledovaniia zhelchi.

AIM: To determine optimal time of biliary tract decompression and bile reinfusion into gastrointestinal tract in patients with malignant obstructive jaundice. MATERIAL AND METHODS: 179 medical records of patients with obstructive jaundice were analyzed in order to identify risk factors of postoperative complications. Prospective trial included bile examination in 34 patients with malignant obstructive jaundice. The new algorithm of preoperative preparation of patients was proposed using these data. RESULTS: Preoperative hyperbilirubinemia over 50 µmol/l before radical surgery and over 80 µmol/l before palliative surgery is followed by increase of postoperative morbidity from 42.1 to 66.7% and from 11.1 to 37.5%, respectively. The concentration of AST and ALT approaches the norm in 13.63±2.39 days after decompression. Five-day period after external drainage is characterized by the same level of overall bilirubin in the bile while bile reinfusion into gastrointestinal tract after 1-2 days leads to advanced symptoms of intoxication. The proposed tactics allows to reduce postoperative morbidity from 36.9 to 26.5% (p<0.05) and mortality from 5.5 to 2.9%, respectively (p<0.05). CONCLUSION: Duration of biliary decompression should be at least 13.63±2.39 days to reduce postoperative morbidity and mortality. Bile reinfusion into gastrointestinal tract should be started in 5-6 days after decompression.

[Malignant obstructive jaundice management via external biliary drainage followed by bile examination]. / Taktika lecheniia bol'nykh mekhanicheskoi zheltukhoi zlokachestvennogo geneza na osnove issledovaniia zhelchi posle naruzhnogo drenirovaniia biliarnogo trakta (s kommentariem ot redkollegii).

AIM: To determine optimal terms of biliary decompression and bile reinfusion into gastrointestinal tract in patients with malignant obstructive jaundice. MATERIAL AND METHODS: 179 medical records of patients with obstructive jaundice were analyzed to identify risk factors of postoperative complications. Prospective research included bile examination in 34 patients with malignant obstructive jaundice. New algorithm of preoperative management was proposed. RESULTS: Hyperbilirubinemia over 50 µmol/l prior to radical surgery and 80 µmol/l before palliative surgery was followed by postoperative morbidity augmentation from 42.1% to 66.7% and from 11.1% to 37.5%, respectively. Normal AST and ALT concentration after biliary decompression was noted after 13.63±2.39 days. Total bilirubin level in the bile was the same within 5 days after external drainage and bile reinfusion into gastrointestinal tract after 1-2 day was associated with advanced intoxication. New approach is associated with reduced postoperative morbidity from 37.9% to 26.5% (p<0.05) and mortality from 5.5% to 2.9%, respectively (p<0.05). CONCLUSION: Duration of biliary decompression should be at least 13.63±2.39 days to reduce postoperative morbidity and mortality. Bile reinfusion into gastrointestinal tract should be started in 5-6 days after decompression.

[Surgical treatment and different preoperative preparation of patients with malignant tumors of hepatopancreatoduodenal zone].

Different tactical approaches present to optimize surgical treatment of patients with malignant tumors hepatopancreatoduodenal zone. This research based on diagnosis and results of treatment of tumors of this localization, which included 357 analyzed case histories of patients treated in the Chelyabinsk Regional Hospital from 2010 to 2014. During this study was considered the preoperative preparation of patients with malignant obstructive jaundice genesis, and was assessed its impact on the level of postoperative complications and mortality. Farther was found effectiveness of a two-stage surgical treatment of patients with obstructive jaundice malignant etiology for the reduction of postoperative mortality. The complication rate is significantly reduced radically operated patients with bilirubin level below 40 mmol/l, palliative - 80 mmol/l. Also were presented results of treatment of chronic pain.