Abstract
Aim. Improving the immediate results of surgical treatment of liver and biliary tract diseases. Material and Methods. Treatment of 142 patients with postoperative bile leakage was analyzed. Sonography, ERCP, gastroscopy, CT and MRI were used in diagnostics. There were 62 (43.7%) men and 80 (56.3%) women. Postoperative bile leakage was caused by unrepaired biliary hypertension in 14.8% of cases, undiagnosed and unliquidated cystobiliary fistulas – in 40.1%, traumatic lesions of liver and biliary tract – in 10.6 %, clips and drainage tubes dislocation – in 12%, suture failure of cystic duct, common bile duct, biliodigestive anastomoses and duodenal stump – in 22,5%. Results. Bile leakage was treated taking into account its severity and presence of bile hypertension. Endoscopic methods, EPST, biendoscopic interventions (relaparoscopy with cystic duct re-clipping), transduodenal replacement showed high efficiency. Isolated Roux loop hepaticojejunostomy was performed in severe incurable postoperative bile leakage. Complications and deaths were absent. Conclusion. Treatment of patients with postoperative bile leakage requires an individual approach and should include conservative measures, endoscopic and surgical methods of correction.
Highlights
Chair of Surgical Diseases No1 of Abu Ali ibn Sina the Tajik State Medical University, Dushanbe, Tajikistan; 139, Rudaki ave., Dushanbe, 734003, The Republic of Tajikistan
Postoperative bile leakage was caused by unrepaired biliary hypertension in 14.8% of cases, undiagnosed and unliquidated cystobiliary fistulas – in 40.1%, traumatic lesions of liver and biliary tract – in 10.6 %, clips and drainage tubes dislocation – in 12%, suture failure of cystic duct, common bile duct, biliodigestive anastomoses and duodenal stump – in 22,5%
Isolated Roux loop hepaticojejunostomy was performed in severe incurable postoperative bile leakage
Summary
Абуали ибни Сино, Душанбе, Таджикистан; 734003, г. Улучшение непосредственных результатов хирургического лечения заболеваний печени и желчевыводящих путей. Анализировали результаты лечения 142 пациентов с послеоперационным желчеистечением. Мужчин было 62 (43,7%), женщин – 80 (56,3%). Причиной послеоперационного желчеистечения в 14,8% наблюдений стала неустраненная билиарная гипертензия, в 40,1% – неликвидированные цистобилиарные свищи, в 10,6% – травматические повреждения желчных протоков и печени, в 12% – смещение клипс, выпадение дренажей, в 22,5% – несостоятельность швов пузырного протока, общего желчного протока, билиодигестивных анастомозов и культи двенадцатиперстной кишки. Высокую эффективность показали эндоскопичекие методы, ЭПСТ, биэндоскопические вмешательства (релапароскопия с повторным клипированием пузырного протока), трансдуоденальное протезирование. Лечение пациентов с желчеистечением после операций требует индивидуального подхода, должно включать консервативные мероприятия, эндоскопические и хирургические методы коррекции. Ключевые слова: печень, желчные протоки, желчеистечение, цистобилиарный свищ, эндоскопические вмешательства
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