Abstract
Aim . To develop rational surgical tactics for the treatment and prevention of bile duct lesions in patients with acute calculous cholecystitis. Materials and methods . The results of examination and surgical treatment of 1,645 patients with acute calculous cholecystitis at the second and third levels of medical care were studied. The results of diagnostics and elimination of the bile ducts injuries in 21 patients who developed during laparoscopic cholecystectomy for acute cholecystitis in second-level medical institutions were analyzed. Integrative assessment of the examination results is based on taking into account the results of laboratory and instrumental examination. Based on the analysis, a rational treatment strategy for this category of patients was formed and tested. Results . The main factors that influenced the occurrence of bile duct injuries were: performing the operation in an inflammatory infiltrate and within 72 hours of the onset of the disease, intrahepatic location of the gallbladder, male gender and age over 63 years ( p ≤ 0.05). The provision of assistance in case of complete damage to the main bile ducts in medical organizations of the second level should be completed by performing external drainage with further evacuation of the patient, after stabilization of his condition, to medical institutions of the third level. Partial common bile ducts injury can be eliminated by performing restorative suturing of the defect of the common bile duct the T-drainage at all levels of healthcare organization. It was clarified that patients with acute cholecystitis Grade I are shown timely laparoscopic cholecystectomy within 72 hours from the onset of the disease. For patients with acute Grade II cholecystitis complicated by inflammatory infiltrate, without signs of destruction and blockage of the gallbladder at all levels of medical care it is advisable to conservative treatment, surgery after 3 months. With the progression of endogenous intoxication with destruction of the gallbladder, cholecystostomy is advisable. Patients with acute grade II cholecystitis and complicated course who are being treated in a second-level medical organization, are shown to be transferred to a third-level medical organization for endoscopic intervention on the duodenal papilla. Conclusion . Implementation of the proposed surgical tactics for patients with acute cholecystitis allows performing timely and rational surgical intervention, increasing the effectiveness of treatment, reducing the number of postoperative complications and mortality.
Highlights
лапароскопическая холецистэктомия (ЛХЭ) ЛХЭ, чреспузырная литэкстракция, дренирование основные желчевыводящие протоки (ОЖП) по Холстеду ЛХЭ, дренирование ОЖП по Холстеду ЛХЭ, холедохолитотомия, дренирование ОЖП Т-образным дренажом ЛХЭ, ЭПСТ, дренирование ОЖП по Холстеду ЛХЭ, дренирование ОЖП по Холстеду, послеоперационная ЭПСТ ЭПСТ, ЛХЭ, дренирование ОЖП по Холстеду ЭПСТ, холедохолитэкстракция, стентирование ОЖП Чрескожное чреспеченочное дренирование под контролем УЗИ
Surgical repair of bile duct injuries following laparoscopic cholecystectomy: the sooner the better
Summary
Изучены результаты обследования и лечения 1645 больных ОХ. Первая, ретроспективная группа сформирована из 1160 больных, находившихся на лечении в центральных районных и клинических межрайонных больницах Ленинградской области, соответствующих второму уровню оказания медицинской помощи (ОМП), в 2005–2020 гг. Согласно системе оценки тяжести ЛХЭ [10], простые и средней сложности оперативные вмешательства были выполнены в 780 наблюдениях, сложные – в 248 и экстремальные – в 23. Анализируя срок поступления больных с ТЖП, установлено, что в течение 3–24 ч от начала заболевания на стационарное лечение поступили 2 больных ОХ, в сроки от 24 до 72 ч – 4 и от 72 ч до 7 сут – 14 пациентов. Согласно системе оценки тяжести ЛХЭ, сложными оперативные вмешательства были у 19 больных, экстремальными – у 2. Повлиявшими на возникновение ТЖП, длительность оперативного вмешательства, конверсию, стали выполнение операции в условиях воспалительного околопузырного инфильтрата, операция >72 ч от начала заболевания, внутрипеченочное расположение желчного пузыря, мужской пол и возраст старше 63 лет (p ≤ 0,05). Повреждение НЖП характеризовалось повреждением ходов Люшка в области ложа желчного пузыря у обоих пациентов (рис. 1)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
