PREVENTION OF PURULENT CHOLANGITIS AFTER PERCUTANEOUS ENDOBILIARY TRANSPAPILLARY DRAINAGE IN PATIENTS WITH OBSTRUCTIVE JAUNDICE
Abstract
Introduction. The incidence of cholangitis varied from 9 % to 33 % after the insertion of transpapillary external-internal endobiliary drainage. In case of proximal bile obstruction, the method of suprapapillary insertion of external-internal drainage were widely used for prevention of purulent complications. But it was impossible to use this method in case of distal bile obstruction. The choice of initial decompression method for distal bile duct obstruction (external only or transpapillary external-internal drainage) was unclear.The objective was to improve results of primary percutaneous transhepatic biliary drainage in patients with jaundice and distal bile duct obstruction.Material and methods. As a primary decompression method, percutaneous transhepatic endobiliary interventions under ultrasound and X-ray control were performed in 81 patients with distal bile duct obstruction. External-internal transpapillary drainage were performed in 30 patients, only external drainage – in 21 patients and in 31 patients we used original combined technique (compilation of external and external-internal transpapillary drainage).Results. Intraoperative and early postoperative complications were noticed in 23 patient (28 %). Complications in the group of external endobiliary drainage were observed in 4 (19 %) patients. In the group of external-internal drainage, complication rate was 53.3 % (16 patients). At the same time, purulent complications were noted in 30 % of cases (9 people). In case of using combined external-internal drainage, no purulent complications was diagnosed. In the treatment of all complications, minimally invasive methods were successfully used.Conclusion. Our results showed advantages of the original combined technique due to the absence of the risk of purulent complications, and ensuring transpapillary access at the same time.
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