Percutaneous Transhepatic Endobiliary Lithotripsy in Treatment of Patients with Megacholedocholithiasis

Abstract


Relevance Large (>20mm.) common bile duct stones pose difficulties for endoscopic lithotripsy, severe somatic pathology limits conditions for performing laparoscopic and traditional operations. The purpose of the study Exploring endobiliary lithotripsy through greater access (28Fr.) to treatment megacholedocholithiasis. Materials and methods Results of treatment of 45 patients with complicated forms of cholelithiasis against severe physical illness. Complications of gallstone disease are: megacholedocholithiasis, the terminal part of the common bile duct stenosis, obstructive jaundice, acute purulent cholangitis, liver abscesses, hepatolithiasis and destructive cholecystitis. In patients with obstructive jaundice priority percutaneous biliary decompression based on ultrasonic gradation types of biliary hypertension and limited ability transpapillary endoscopic methods in large, blocking the common bile duct stones.The division of patients with obstructive jaundice into classes A B C can rationally choose a surgical approach based on the prediction of the alleged fatal outcome. All patients underwent percutaneous transhepatic biliary lithoextraction because of the "high" operational and anesthetic risks of traditional surgery and the inability to endoscopic removal of biliary tract calculi. Results and their discussion Made the first step, percutaneous transhepatic cholangiostomy eliminates pathogenic cholehemia and systemic endotoxemia, which is especially necessary in elderly patients with somatic diseases. The use of percutaneous transhepatic lithotripsy endobiliary of megacholedocholithiasis made through consistently shaped, large-caliber transhepatic working channel(28Fr) eliminated the biliary obstruction with minimal complications - 8.8%. Conclusion The findings suggest, endobiliary transhepatic lithotripsy is the treatment of choice for patients with megacholedocholithiasis and high operational and anesthetic risk

Kursk State Medical University, 3 K.Marksa Str., Kursk, 305041, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com

Russian Federation MD, Professor, Head of the Department of Surgical Diseases FPE of the KSMU, rector of the Kursk State Medical University

Kursk Regional Clinical Hospital, 45a Sumskaia Str., Kursk, 305007, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation MD, Professor of Surgical Diseases FPE of the KSMU, Rector for continuing education and medical work of the KSMU, head of DCR department № 2 of the Kursk Regional Clinical Hospital

Kursk State Medical University, 3 K.Marksa Str., Kursk, 305041, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation MD, Professor of Surgical Diseases FPE of the KSMU

Kursk State Medical University, 3 K.Marksa Str., Kursk, 305041, Russian Federation
Kursk Regional Clinical Hospital, 45a Sumskaia Str., Kursk, 305007, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation PhD, Assistant Professorof Surgical Diseases FPE of the KSMU, head of purulent surgery department of the Kursk Regional Clinical Hospital

Kursk State Medical University, 3 K.Marksa Str., Kursk, 305041, Russian Federation
Kursk Regional Clinical Hospital, 45a Sumskaia Str., Kursk, 305007, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation doctor first qualification category of general surgery department of the Kursk Regional Clinical Hospital, seeker of surgical diseases FPE

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