Синдром ”быстрой” билиарной декомпрессии при лечении механической желтухи

Objective. To improve the outcomes in patients with obstructive jaundice by well-timed prognosis, early diagnosis and effective treatment of “rapid” biliary decompression syndrome. Material and methods. The outcomes in 5792 patients with obstructive jaundice for the period 2007–2018 were analyzed. There were 7179 minimally invasive drainage procedures including 5013 (69,8%) endoscopic transpapillary interventions, 288 (4,0%) percutaneous transhepatic procedures and 1878 (26,2%)combined interventions. Incidence of postoperative complications including “rapid” biliary decompression syndrome and mortality rate were analyzed. Results. Twelve patients died due to progression of hepatic failure ( n = 5) and hepatorenal syndrome ( n = 7). “Rapid” biliary decompression in early postoperative period was diagnosed in 11 patients. Clinical and laboratory prognostic criteria and signs of “rapid” biliary decompression syndrome were proposed using calculation of biliary decompression rate and decrease of bilirubin level. A treatment algorithm was developed. Conclusion . Preoperative biliary drainage in patients with severe obstructive jaundice can result “rapid” biliary decompression syndrome. Clinical manifestations of this syndrome include various symptoms (hepatic failure, hepatorenal syndrome, hepatic encephalopathy and coagulopathy) and their combination that requires emergency management.