Особенности тактики и хирургического вмешательства при свежем ятрогенном повреждении общего печеночного протока

Abstract

The aim of the study was to select the most optimal method for completing the operation in case of "fresh" iatrogenic damage to the common hepatic duct, which ensures a favorable course of the postoperative period and preparation for the subsequent reconstructive operation. Material and methods. The study was based on the analysis of the results of surgical treatment of 58 patients with iatrogenic damage to the extrahepatic bile ducts (EPBD) for the period from 1998 to 2018. All patients had complete "fresh" transverse transection or clamping (clipping, ligation) of the common hepatic duct during cholecystectomy. In the first group (40 patients), the operation was completed by drainage of the common hepatic duct with a "free" position of the drainage under the liver and drainage of the subhepatic region; in the second group (18 patients), the drainage of the bile duct was fixed in the bed of the gallbladder, with the formation of a Maidl-type jejunostoma to return bile. Research results and their discussion. All patients (58 people) were initially operated on in hospitals in the Tyumen region and the city of Tyumen. 32 patients (55%) underwent open cholecystectomy, 26 (45%) – laparoscopic. The operation was performed in 13 patients (22%) as planned, in 45 (78%) as an emergency. In 40 (69%) operated patients, when the gallbladder was removed, the common hepatic duct was cut, in 18 (31%) it was clipped (ligated). Out of 40 patients (first group), bile duct transection occurred with open cholecystectomy in 29 (72.5%) people, in 11 (27.5%) with laparoscopic intervention. In all, the trauma of the hepatic duct was noticed by the operating surgeon during the operation. In accordance with the adopted tactics, the surgeon through the CMH contacted the experienced surgeon on duty at the Regional Hospital (GBUZ TO "OKB № 1"), with whom he agreed on the method of completing the operation. Conclusion. The lack of experience of hospital surgeons both in solving a tactical problem, when crossing an AKI or clipping it, and in performing a reconstructive operation after an injury is detected, we consider it expedient to introduce drainage into the proximal section of the intersected duct and transport the patient to a hospital department where there are specialists with such experience. operations. Fixation of the drainage of the common hepatic duct in the bed of the gallbladder, the formation of a Maidl-type jejunostoma with a complete return of bile to the intestine can effectively prepare the patient for reconstructive surgery, improve the technical conditions for its implementation.