Effectiveness and complications of percutaneous interventions with biliary tract obstruction

Abstract

Background. Disturbances of biliary excretion along the biliary tract can be caused by many diseases of benign and malignant genesis and, in turn, are the cause of the development of life-threatening complications. These complications are associated with the development of inflammation of the biliary tract and the emergence of cholangitis with the subsequent spread of the septic process, as well as the occurrence of nephrectomy with subsequent lesion of other vital organs and multiple organ failure. Aim of the study. Improvement of surgical treatment in case of obstruction of biliary tract and in cholangiogenic liver abscesses by using minivivasive percutaneous drainage interventions and reducing the number of complications. Materials and methods. The results of surgical treatment of 73 patients with obstructive lesions of the gallbladder system in which the endoscopic transpulsion approach was non-objective (in the vast majority due to the impossibility of cannulation of the duodenal papilla) were analyzed, as well as 41 patients with cholangiogenic abscesses liver. For percutaneous drainage of biliary tract in cholangitis and cholangiogenic liver abscesses were used catheters 8-12 Fr under the control of ultrasound in X-ray operating room. Results and discussion. The vast majority of patients who had transcutaneous transpirational biliary drainage had malignant neoplasms of the pancreas and bile duct head– 61 patients, and 9 patients were drainage for benign hepaticocholedochol strictures. Among 70 patients after transcutaneous transhepatic drainage of the bile ducts, there were complications in 9 patients (12.9%). After percutaneous drainage of liver abscesses in 41 patients, complications occurred in 9 patients (21.9%). Conclusions. Proceeding from the etiology of the pathological process, indications for intracirculatory interventions with biliary tract obstruction can be divided into the following groups: "biliary", "septic" and "mixed". "Biliary" indications mean the need to eliminate biliary hypertension, "septic"– the elimination of purulent liver formations, and "mixed"– a combination of the above factors. Percutaneous interventions with bile duct obstruction and cholangiogenic abscesses are accompanied by low lethality, and the complications of drainage can be eliminated by the use of minimally invasive technologies. In the presence of a distance from the cavity of the liver cholangiogenic abscess to the liver capsule of less than 10 mm deserves attention to the decision to use "open" or laparoscopic intervention. The study confirms the possibility of percutaneous drainage and biliary tree and cholangiogenic abscesses in one patient as separate drainages and one general drainage.