nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-177-5-108-112nogr-1338Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL CASESДлительный стойкий эффект после двойного дуоденального и ЭУС-ассистированного билиодуоденального стентирования больного с осложненным метастатическим поражением органов билиопанкреатодуоденальной зоныSustainable effectiveness of double duodenal and EUS-guided transmural biliary drainage in a patient with metastasis to biliopancreatoduodenal zoneБурдюковМ. С.BurdyukovM. D.

Mikhail S. Burdyukov, MD, PhD, associate Professor of the Department of endoscopy

Moscow

burdyukovms@gmail.comЮричевИ. Н.NechipaiA. M.

Andrei M. Nechipai, endoscopist

Moscow

НечипайА. М.YurichevI. N.

Ilya N. Yurichev, endoscopist

Moscow

ПановВ. О.PanovV. O.

Vadim O. Panov, endoscopist

Moscow

ФГБОУ ДПО РМАНПО Минздрава России; Европейская клиника (Центр инновационных медицинских технологий г. Москва); ГБУЗ ГКБ им.С.П.Боткина ДЗМРоссияRussian Medical Academy of Continuous Professional Education; Center for Innovative Medical Technologies; Botkin HospitalRussian FederationФГБУ «НМИЦ онкологии им. Н. Н. Блохина» МЗ РФРоссияN. N. Blokhin National Medical Research Center of OncologyRussian FederationФГБОУ ДПО РМАНПО Минздрава РоссииРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation2020290620201745108112Copyright © Бурдюков М.С., Юричев И.Н., Нечипай А.М., Панов В.О., 20202020Бурдюков М.С., Юричев И.Н., Нечипай А.М., Панов В.О.Burdyukov M.D., Nechipai A.M., Yurichev I.N., Panov V.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1338

У пациентов с местнораспространенными первичными и вторичными злокачественными поражениями органов и тканей билиопанкреатодуоденальной зоны закономерно развиваются механическая желтуха и нарушение проходимости двенадцатиперстной кишки. Традиционно, в подобных случаях оказывается симптоматическое хирургическое пособие в объеме формирования обходных гастроэнтеро- и гепатико-/холецисто-энтероанастомозов. Однако, на высоте механической желтухи выполнение паллиативных вмешательств сопряжено с высоким риском развития осложнений и летальных исходов. В таких случаях применение внутрипросветного эндоскопического стентирования позволяет разрешать непроходимость ДПК, а эндоскопическое дренирование желчных протоков — механическую желтуху. Однако, применение ретроградного дренирования при опухолевом стенозе двенадцатиперстной кишки в большинстве случаев невыполнимо. В этой связи возможно выполнение дренирование желчных протоков под контролем эносонографии. Данное клиническое наблюдение посвящено эндоскопическому лечению пациента с опухолевым поражением панкреотодуоденальной зоны, осложненным стенозом двенадцатиперстной кишки и механической желтухой с применением рентгено-эндоскопическим методик и эндосонографии.

Obstructive jaundice with duodenal obstruction are often encountered in patients with primary cancer or metastasis to bilipancreatoduodenal zone. Usually palliative surgery involving creation of gastroentero and liver-cholecysteneteroanas-tamosis is used. This palliative surgery carries a high risk of complications and death if performed at the height of jaundice. In this case endoscopic stenting of duodenum or EUS-guided transmural biliary drainage may be preferred method of treatment. At the same time in the majority of patients performing of ERCP in cases of duodenum obstruction is not technically feasible. In this case EUS-guided transmural biliary drainage can be implemented. This clinical case demonstrates endoscopic treatment of a patient with pancreatoduodenal cancer complicated by duodenal obstruction and obstructive jaundice using endosonography and x-ray guided endoscopy.

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The authors declare that there are no conflicts of interest present.