title: [Percutaneous cholangiostomy for portal cholangiocarcinoma].
abstract: OBJECTIVE
  to analyze the efficacy of interventional methods in treatment of Klatskin tumor patients.
  
  
  METHODS
  Treatment of 133 patients with Klatskin tumor for the period 2000-2015 was analyzed. Bismuth I type was revealed in 28 (21.1%) cases, type II  - in 45 (33.8%) cases, type III - in 51 (38.3%) cases, type IV - in 9 (6.8%) cases. All patients underwent sonofluoroscopy-assisted percutaneous transhepatic cholangiostomy using self-fixing Pig tail 8Fr drains at the first stage followed by externointernal drainage or antegrade biliary stenting. We deployed 1-6 drains simultaneously or step by step depending on severity of biliary occlusion.
  
  
  RESULTS
  Technical success was achieved in all patients. Major postoperative complication such as drain dislocation followed by advanced biliary peritonitis was observed in 1 (0.8%) case. Minor complications occurred in 22 (16.5%) patients. In-hospital mortality was 7.5% (10 patients). The cause of death was severe liver-renal failure. Liver abscesses occurred in 13 patients after transpapillary externointernal drainage on background of temporary occlusion of biliary drain. This required interventional surgery.
  
  
  CONCLUSIONS
  Obstructive jaundice management should be performed using interventional techniques simultaneously or step by step if unresectable tumor or inoperable patient are present. Herewith it is advisable to restore bile flow in maximal volume of liver parenchyma. Use of uncovered self-expanding biliary stents for palliative treatment of Klatskin tumor may be realized in «hybrid» variant to control stent patency as well as for neoadjuvant therapy of tumor.
authors.affiliation: Department of Endovascular Diagnosis and Treatment #2, Kursk Regional Clinical Hospital; Department of Radiological Diagnosis and Therapy and Department of Surgical Diseases, Faculty of Postgraduate Education, Kursk State Medical University, Russia.
authors.forename: O I
authors.initials: OI
authors.lastname: Okhotnikov
authors.affiliation: Department of Endovascular Diagnosis and Treatment #2, Kursk Regional Clinical Hospital; Department of Radiological Diagnosis and Therapy and Department of Surgical Diseases, Faculty of Postgraduate Education, Kursk State Medical University, Russia.
authors.forename: M V
authors.initials: MV
authors.lastname: Yakovleva
authors.affiliation: Department of Endovascular Diagnosis and Treatment #2, Kursk Regional Clinical Hospital.
authors.forename: V I
authors.initials: VI
authors.lastname: Pakhomov
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology; D002758:Cholangiography / Q000379:methods; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D018285:Klatskin Tumor / Q000150:complications / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010166:Palliative Care / Q000379:methods; D010538:Peritonitis / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D019919:Prosthesis Implantation / Q000009:adverse effects; D012189:Retrospective Studies; D012426:Russia / Q000453:epidemiology; D000069322:Self Expandable Metallic Stents; D054047:Surgical Stomas / Q000009:adverse effects; D014463:Ultrasonography / Q000379:methods