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 

作者机构：Department of Surgery with the Course of Emergency and Vascular SurgeryO.O.Bogomolets National Medical UniversityKyiv 01601Ukraine Department of Abdominal SurgeryNational Military Medical Clinical Centre“Main Military Clinical Hospital”Kyiv 01133Ukraine Department of Microbiology and ImmunologyTaras Shevchenko National University of KyivKyiv 01033Ukraine 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2023年第15卷第4期

页      面：698-711页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Distal malignant biliary obstruction Obstructive jaundice Bile duct decompression Palliative endoscopic biliary drainage Internal-external biliary-jejunal drainage 

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 *** reduce the unfavorable effects of BD decompression,minimally invasive surgical techniques require continuous *** 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 *** A retrospective analysis of prospectively collected data was performed,which included 134 patients with DMBO who underwent palliative BD ***-jejunal drainage was developed to divert bile from the BD directly into the initial loops of the small intestine to prevent duodeno-biliary *** was carried out using percutaneous transhepatic *** 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 *** 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 *** 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 t