zdorПроблемы здоровья и экологииHealth and Ecology Issues2220-09672708-6011Gomel State Medical University10.51523/2708-6011.2024-21-3-08zdor-2761Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEРезультаты одноэтапных операций при опухолях билиопанкреатодуоденальной зоны, осложненных механической желтухойResults of one-step surgery in periampullary tumors complicated by obstructive jaundicehttps://orcid.org/0000-0002-3796-0342МихайловИ. В.MikhailovI. G.

Михайлов Игорь Викторович, к.м.н., доцент, заведующий кафедрой онкологии, 

Гомель

Igor V. Mikhailov, Candidate of Medical Sciences, Associate Professor, Head of the Department of Oncology,

Gomel

igor-mikhailov-2014@yandex.ruУО «Гомельский государственный медицинский университет»Belarus2024220720242135865Copyright © Михайлов И.В., 20242024Михайлов И.В.Mikhailov I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.gsmu.by/jour/article/view/2761Цель исследования

Цель исследования. Проанализировать ближайшие и отдаленные результаты хирургического лечения пациентов с опухолями органов билиопанкреатодуоденальной зоны (БПДЗ) в зависимости от проведения предоперационного билиарного дренирования (ПБД).

Материалы и методы

Материалы и методы. В обсервационном ретроспективном исследовании проведен анализ результатов хирургического лечения 249 пациентов со злокачественными опухолями органов БПДЗ в зависимости от проведения ПБД (выполнена в 119 случаях). Основным показанием для проведения ПБД являлся уровень общего билирубина выше 200 мкмоль/л (с 2015 г. — выше 250 мкмоль/л).

Результаты

Результаты. Общая частота послеоперационных осложнений у пациентов, оперированных одноэтапно и перенесших ПБД составила 43,1 и 41,2 %, частота тяжелых осложнений (≥ IIIa ст. по Clavien – Dindo) — 20,8 и 17,6 % (p > 0,05), панкреатической фистулы — 26,2 и 25,2 % (p > 0,05), госпитальная летальность — 7,7 и 3,4 % (p = 0,14), 90-дневная летальность — 8,7 и 4,3 % (p = 0,17). Общая пятилетняя выживаемость в группах без ПБД и с ПБД составила при раке фатерова сосочка — 45,0±8,5 и 20,2±8,4 % (p = 0,36), раке общего желчного протока — 66,7±19,2 и 55,6±16,6 % (p = 0,77), раке головки поджелудочной железы (ПЖ) всех гистологических вариантов — 34,7±5,9 и 4,2±2,7 % (p = 0,00001), протоковой аденокарциноме ПЖ — 27,0±6,2 и 2,3±2,2 % (p = 0,002).

Заключение

Заключение. Выполнение одноэтапных операций при опухолях БПДЗ не сопровождалось ростом общей частоты послеоперационных осложнений, частоты тяжелых (≥ IIIa степени по Clavien – Dindo) осложнений, госпитальной и 90-дневной летальности в сравнении с двухэтапными операциями. У пациентов с раком фатерова сосочка и раком общего желчного протока различий показателей выживаемости в зависимости от проведения ПБД не выявлено. При раке головки ПЖ наблюдалось снижение показателей общей выживаемости пациентов, перенесших ПБД, в сравнении с оперированными без ПБД, особенно среди пациентов с протоковой аденокарциномой ПЖ, что требует совершенствования подходов к лечению данной категории пациентов.

Objective

Objective. To analyse the immediate and remote results of surgical treatment of patients with periampullary tumors, depending on the presurgery biliary drainage (PBD).

Materials and methods

Materials and methods. In an observational retrospective study, the results of surgical treatment of 249 patients with malignant periampullary tumors were analyzed, depending on the PBD (performed in 119 cases). The main indication for PBD was the level of total bilirubin above 200 μmol/l (since 2015 – above 250 μmol /l).

Results

Results. The overall incidence of postsurgery complications in patients underwent one–step surgery and underwent PBD was 43.1 and 41.2%, the incidence of severe complications (≥IIIa according to Clavien – Dindo) was 20.8 and 17.6% (p>0.05), pancreatic fistula – 26.2 and 25.2% (p>0.05), hospital mortality – 7.7 and 3.4% (p=0.14), 90-day mortality – 8.7 and 4.3% (p=0.17). The overall five–year survival rate in the groups without PBD and with PBD was 45.0±8.5 and 20.2±8.4 (p=0.36) for cancer of the Fater papilla, 66.7±19.2 and 55.6±16.6 (p=0.77) for cancer of the common bile duct, 34.7±5.9, and 4.2±2.7 for pancreatic cancer (PC) of all histological variants – 34.7±5.9 and 4.2±2.7 (p=0.00001), ductal adenocarcinoma PC – 27.0±6.2 and 2.3±2.2% (p=0.002).

Conclusion

Conclusion. One-step surgeries for periampullary tumors were not accompanied by an increase in the overall frequency of postsurgery complications, the frequency of severe (grade IIIa according to Clavien - Dindo) complications, hospital and 90-day mortality, compared with two-stage surgeries. In patients with cancer of the Fater papilla and cancer of the common bile duct, there were no differences in survival rate depending on the PBD. In pancreatic head cancer, there was a decrease in the overall survival rate of patients underwent PBD in comparison with those surgically operated without PBD, especially among patients with ductal adenocarcinoma of the pancreas, which requires improved approaches to the treatment of this category of patients.

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The authors declare that there are no conflicts of interest present.