Хирургическое лечение альвеококкоза, осложненного механической желтухой

Abstract

Aim. To analyze clinical features and surgical results in patients with liver alveococcosis complicated by obstructive jaundice. Material and Methods. 39 patients with liver alveococcosis complicated by obstructive jaundice were operated. 49 different interventions were carried out. General clinical diagnosis and modern instrumental methods of examination were used. Results. The incidence of jaundice in liver alveococcosis was 14.1%, duration of the disease was over 10 years, duration of jaundice – from several months to several years. 3 types of clinical course were observed. 65.5% of patients had other complications of parasitic process, 30% – combination of several complications. 55.4% of patients have already been operated previously. 65% of patients had severe liver failure at admission. The main method of diagnosis was ultrasound. Nasobiliary drainage and percutaneous transhepatic cholangiostomy were used for preoperative biliary decompression. All patients underwent only drainage operations (within two stages as a rule). NiTi-stents were used for external drainage, fistuloenterostomy in 11 patients with good results. The mortality rate was 10.2%. Conclusion. Obstructive jaundice in liver alveococcosis has three types of course depending on process localization. They have different duration and severity of cholestasis. Two-stage surgery is advisable and NiTi-stents are perspective. Drainage operations prolong life of inoperable patients for about 6.5 ± 1.2 years.