Diagnosis and treatment of biliary hypertension syndrome in chronic pancreatitis
- Authors: Shaymardanov RS1, Gubaev RF2, Khamzin II2, Nuriev II2
-
Affiliations:
- Kazan state medical academy
- City clinical hospital №7
- Issue: Vol 97, No 6 (2016)
- Pages: 828-832
- Section: Theoretical and clinical medicine
- URL: https://kazanmedjournal.ru/kazanmedj/article/view/5626
- DOI: https://doi.org/10.17750/KMJ2016-828
- ID: 5626
Cite item
Full Text
Abstract
Aim. To study the efficacy and pancreatic and biliodigestive bypass surgeries combined with or without resection of the pancreatic head in the surgical treatment of biliary hypertension syndrome in chronic pancreatitis.
Methods. The analysis of surgical treatment of 87 patients with chronic pancreatitis complicated with biliary tract obstruction was performed. In 78 patients the strictures were tubular and had a length of 2-4 cm, 9 patients had «rat’s tail» shaped strictures and a length of 5-7 cm.
Results. In 37 patients various biliodigestive anastomoses without intervention on the pancreas were performed. Unsatisfactory results of choledochoduodenal anastomosis in chronic pancreatitis in long-term follow-up were reported in 3 of 8 interviewed patients. The optimal variant of biliodigestive bypass in chronic pancreatitis with biliary hypertension syndrome is hepaticojejunal anastomosis. In 13 patients different interventions on biliary tract in combination with resection of pancreatic head by Frey were performed. In 13 patients with obstructive forms of chronic pancreatitis with severe pancreatic hypertension pancreaticojejunostomy without resection of the pancreatic head was performed. In the long-term follow up after these surgeries in 7 out of 10 patients the signs of biliary hypertension did not completely resolve. The best results were obtained by using draining pancreatic duct interventions with pancreatic head resection by Frey.
Conclusion. In tubular pancreatogenic strictures of the common bile duct when the symptoms of biliary hypertension are severe, the method of choice is hepaticojejunal anastomosis; duodenum preserving resection of pancreatic head in chronic pancreatitis complicated with biliary hypertension should be combined with bile duct draining operations.
About the authors
R S Shaymardanov
Kazan state medical academy
Author for correspondence.
Email: nurievmd@gmail.com
R F Gubaev
City clinical hospital №7
Email: nurievmd@gmail.com
I I Khamzin
City clinical hospital №7
Email: nurievmd@gmail.com
I I Nuriev
City clinical hospital №7
Email: nurievmd@gmail.com
References
- Багненко С.Ф., Курыгин А.А., Рухляда Н.В., Смирнов А.Д. Хронический панкреатит. Руководство для врачей. СПб.: Питер. 2000; 116 с.
- Гальперин Э.И., Дюжева Т.Р., Ахаладзе Г.Г. Хронический панкреатит, резекционные и дренирующие вмешательства. Хирургия. 2006; (8): 4-9.
- Данилов М.В., Говоров С.А., Зурабиани В.Г. Повторные и реконструктивные операции при осложнениях и рецидивах традиционных и минимально инвазивных хирургических вмешательств у пациентов с рецидивирующим панкреатитом. Альманах ин-та хир. им. А.В. Вишневского. 2011; (2): 11-12.
- Добров С.Д., Полякович А.С., Толстых Б.Н. Жёлчная гипертензия у больных хроническим панкреатитом. Анн. хир. гепатол. 2012; 17 (4): 35-40.
- Шастный А.Г., Петров Р.В., Егоров В.И. Результаты duodenum-сохраняющей резекции головки поджелудочной железы по Бегеру при хроническом панкреатите. Анн. хир. гепатол. 2011; 16 (1): 72-78.
- Abdallach A.A., Krige Y.Y., Boruman P. Biliary tract obstruction in chronich pancreatitis. HPB. 2007; 9: 421-428. http://dx.doi.org/10.1080/13651820701774883
- Frey Ch.F., Suzuki M., Isagi S. Treatment of chronich pancreatitis by obstruction of the bile duct or duodenum. Wed Y. Surg. 1990; 14: 59-69. http://dx.doi.org/10.1007/BF01670547
- Keck T., Marianovic Y., Fernandez-del Castilloc. The infammatori pancreatic head mass: significant differences in the anatomic pathology of German and American patients with chronich pancreatitis determine very different surgical strategies. Ann. surg. 2009; 249 (1): 105-110. http://dx.doi.org/10.1097/SLA.0b013e31818ef078
- Schlosser W., Schwarz B., Beger G.A. Surgical treatment of chronich pancreatitis main duct dilatation: long term results after resection and duct drainage. HPB. 2005; 7: 114-119. http://dx.doi.org/10.1080/13651820510028774
- Zi Yin, Jian Sun, Dong Yin, Jie Wang. Surgical treatment strategies in chronic pancreatitis. Arch. Surg. 2012; 147: 961. http://dx.doi.org/10.1001/archsurg.2012.2005