DOI: 10.25881/20728255_2022_17_2_36

Authors

Ruziboyzoda K.R.

Avicenna Tajik State Medical University, Dushanbe, Tajikistan

Abstract

Improving the results of treatment of patients with obstructive jaundice by reducing the incidence of “rapid decompression” syndrome.

Material and methods. The results of complex diagnostics, diagnostics and treatment of 84 patients with “rapid decompression” syndrome with obstructive jaundice are analyzed. The “rapid decompression” syndrome most often developed in 36 (42.9%) cases after percutaneous-transhepatic cholangiostomy due to obstructive jaundice. In 34 (40.5%) cases after the formation of a traditional cholecystostomy (n = 17) and drainage of the common bile duct (n = 17). Only in 14 (16.6%) cases it developed after endoscopic papilosphincterotomy with nasobiliary drainage.

To diagnose the “rapid decompression” syndrome, patients underwent dynamic ultrasound examination, studied the daily flow of bile according to the installed drains, as well as the rate of decompression of the bile ducts. To calculate the biliary rate, we used the formula proposed by T. Shimizu and modified by E.I. Galperin.

Results. Depending on the methods of decompression of the bile ducts, the “rapid decompression” syndrome developed at different times of the post-decompression period. After percutaneous transhepatic cholangiostomy, the syndrome of “rapid decompression” developed on days 3–4 of the post-decompression period in 74% of patients, and in patients after traditional cholecystostomy and external drainage of the common bile duct on days 5–6 in 91% of patients.In the group of patients who underwent endoscopic decompression with nasobiliary drainage, the timing of the appearance of this syndrome was noted on days 7–8 in 94% of cases. It should be noted that the later this complication develops, the easier they are tolerated by patients.

Conclusion. Thus, the treatment of patients with “rapid decompression” syndrome should be comprehensive and based on the data of the clinical manifestation of the disease, indicators of laboratory and ultrasound methods.

Keywords: diagnostics, treatment, obstructive jaundice, rapid decompression syndrome.

References

1. Kurbonov KM, Nazirboev KR. Diagnostics and tactics of treatment of complications of minimally invasive decompressive interventions in obstructive jaundice. Bulletin of Postgraduate Education in Healthcare. 2017; 4: 52-55. (In Russ).

2. Galperin EI. Obstructive jaundice: the state of «imaginary stability», the consequences of the «second blow», the principles of treatment. Annals of surgical hepatology. 2011; 16(3): 16-25 (In Russ).

3. Shimizu T, Sato O, Tsukada K. Reestimation of the bilirubin decrease rate «b» (b value) in patients with obstructive jaundice. J. Hep. Bil. Pancr. Surg. 1996; 3(1): 12-16.

4. Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat. Dis. Int. 2018; 17(1): 17-21.

5. Kulezneva YuV, Melekhina OV, Kurmanseitova LI, Efanov MG, Tsvirkun VV, Ogneva AYu, Musatov AB, Patrushev IV. Antegrade biliary excretion: analysis of complications and methods for their prevention. Annals of surgical hepatology. 2011; 16(3): 16-25 (In Russ).

6. Nazirboev KR, Kurbonov KM. Ways to improve the results of surgical treatment of obstructive jaundice of benign genesis. Bulletin of the National Medical and Surgical Center. N.I. Pirogov. 2017; 12(4-2): 52-55. (In Russ).

7. Sonnenberg A, Enestvedt BK, Bakis G. Management of Suspected Choledocholithiasis: A Decision Analysis for Choosing the Optimal Imaging Modality. Dig. Dis. Sci. 2016; 61(2): 603-9.

8. Galperin EI., Kotovsky AE, Momunova ON. The rate of decompression of the bile ducts in obstructive jaundice of tumor etiology. Surgery. 2011; 8: 33-40. (In Russ).

9. Zarkua NE. Multilevel drainage of the biliary tract in obstructive jaundice and cholangitis. Bulletin of Surgery. I.I. Grekov. 2013; 172(2): 25-28. (In Russ).

10. Kadyrov DM, Vosiev AS. The value of preliminary percutaneous transhepatic decompression of the bile ducts in obstructive jaundice. Bulletin of the Academy of Medical Sciences of Tajikistan. 2017; 1(21): 36-42 (In Russ).

11. Khoronko YuV, Korobka VL, Groshilin VS, Tolstopyatov SV, Shitikov IV. «Rapid» biliary decompression syndrome in obstructive jaundice surgery. Annals of HPB Surgery. 2019; 24(4): 123-130. (In Russ).

For citation

Ruziboyzoda K.R. Diagnosis and treatment of «rapid decompression syndrome» in obstructive jaundice. Bulletin of Pirogov National Medical & Surgical Center. 2022;2(17):36-39. (In Russ.) https://doi.org/10.25881/20728255_2022_17_2_36