The Algorithm of Treatment Tactics for Patients with Tumor Obstruction of Extrahepatic Bile Ducts

Introduction. The problem of surgical treatment of patients with tumors of the extrahepatic bile ducts is one of the most important and complicated in the surgery of the hepatopancreatoduodenal zone and is of increasing interest to the researchers. The main method that gives a chance to cure cancer patients is the removal of a tumor supplemented with lymphadenectomy, but it can only be performed in 9,0-46,0% of patients. The volume of surgery depends on the localization of the tumor, the extent of its spread – local and regional. The average survival time of patients whose tumors can not be removed does not exceed 6-7 months, whereas after a radical intervention, the five-year survival rate of cancer of such patients is from 8.0 to 42.0%. Aim. To work out an effective algorithm for treating the patients with pulmonary embolism taking into account age and general condition, localization, distribution and stage of the tumor process. Materials and methods. The results of the examination and surgical treatment of 205 patients with pulmonary hypertension, which were treated in the clinic in the period from 1991 to 2012, were analyzed. Men were 99 (48.3%) at the age of 61.6 ± 9.7 years, women – 106 (51.7%) at the age of 62.7 ± 9.5 years. For all the patients there were done complete blood count blood and urinalysis, also the alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase and amylase, bilirubin and its fractions levels have been determined in serum. Among the instrumental examination ultrasonography, computed tomography, magnetic resonance imaging and endoscopic retrograde cholangiography methods to confirm the diagnosis of tumor of the biliary system were applied. The results of these surveys, as well as during the intraoperative audit, determined the tumor's operability. The choice of the method of surgery was determined by the general condition and age of the patient, the localization of the tumor, the degree of its prevalence, the duration of jaundice, the severity of hepatic renal failure and concomitant diseases. Conservative treatment was used to prepare the patient for the surgical intervention, minimally invasive methods of treatment – endoscopic papilloprotectomy, endoscopic stenting and percutaneous throughheat drainage of bile ducts, radical and palliative operations, and intraarterial polychemotherapy. Radical operations were performed for 21.5% patients. While conducting palliative interference a preference was given to internal drainage of bile ducts. Results. It is established that the choice of the method of surgical intervention depends on the localization of the tumor, anatomical features, the stage of the process, previous operations on the bile ducts. Minimal invasive treatment methods – endoscopic stenting, endoscopic papilloprotectomy and percutaneous throughheat drainage with lesser risk for the patient may replace the palliative surgery in cancer patients with non-resection of extrahepatic bile ducts. In patients with nonresectable tumors of extrahepatic bile ducts, it is advisable to use palliative surgical treatment, which increases the rate of annual survival of patients to 63.6%. Conclusions. The required results allowed to differentiate and to individualize the choice of optimal tactics for the patients with tumors of extrahepatic bile ducts and at the same time to minimize a number of postoperation complications. On the basis of required data, the complex algorithm of treatment tactics for patients with tumor obstruction of this localization which consists of four stages has been proposed. The elaborated algorithm promotes the adequate therapeutic tactics and improves treatment outcomes in patients with tumors of extrahepatic bile ducts.