Малоинвазивное хирургическое лечение холедохолитиаза у пациента старческого возраста. Описание собственного клинического случая и техники операции

Abstract

In modern surgery, choledocholithiasis has acquired the status of an independent problem, on the solution of which the further progress of surgery of the hepatobiliopancreatoduodenal zone depends. The article is based on a clinical case of surgical treatment with a diagnosis of a complicated form of cholelithiasis, choledocholithiasis. Purpose of the study. To demonstrate minimally invasive surgical treatment of choledocholithiasis in an elderly patient, based on the example of our own clinical case. Materials and methods. A retrospective analysis of a case of surgical treatment of a complicated form of cholelithiasis, choledocholithiasis, in an elderly patient was carried out. The patient is 84 years old. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), non-cannulation papillosphincterotomy (NPST) and stenting of the common bile duct for choledocholithiasis. The calculi were not removed due to their large size. Later she turned to JSC “NSC” Neftyanik” (Tyumen). Results. Taking into account the patient’s extrahepatic bile duct calculi, the phenomena of previous cholangitis, the patient underwent laparoscopic cholecystectomy, choledochotomy, extraction of calculi and stent, intraoperative choledochoscopy, and completed the operation with laparoscopic choledochoduodenoanastomosis under ETN on 11/19/2019. Conclusion. In this clinical case, we come to the conclusion that the only possible treatment option is the removal of calculi. If it is impossible to remove calculi by minimally invasive antegrade or retrograde methods, they can be considered as preparing the patient for further radical surgical treatment. Modern minimally invasive methods, in particular, laparoscopy, makes it possible to carry out an operation at almost any age aimed at completely eliminating the disease, thereby improving the quality of life.