Percutaneous Transhepatic Endobiliary Lithotripsy in Treatment of Patients with Megacholedocholithiasis


Cite item

Full Text

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

About the authors

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

Author for correspondence.
Email: author@vestnik-surgery.com
MD, Professor, Head of the Department of Surgical Diseases FPE of the KSMU, rector of the Kursk State Medical University Russian Federation

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

Email: author@vestnik-surgery.com
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 Russian Federation

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

Email: author@vestnik-surgery.com
MD, Professor of Surgical Diseases FPE of the KSMU Russian Federation

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

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

References

  1. Akhaladze G. G. And Tsereteli.Yu. Holainov v pecheni abscessy. Annaly hirurgicheskoj gepatologii, [Cholangiogenic liver abscesses. The annals of surgical Hepatology,] 2006; 11: 2: 30-34.
  2. Balalykin A. S. Balalykin.D., In Carnations.In. et al.Diskussionnye voprosy hirurgicheskih vmeshatel'stv na bol'shom ehffektivnosti dvenadcatiperstnoj annaly hirurgicheskoj gepatologii..
  3. [Controversial issues of surgical interventions on the large efficacy of the duodenum.. Annals of surgical Hepatology] 2007,; 12: 4: 57-63.
  4. Galperin E. I. Klassifikaciya tyazhesti zheltuhi. Annaly hirurgicheskoj gepatologii, [classification of the severity of jaundice. The annals of surgical Hepatology,] 2012; 17: 2: 26-33.
  5. Kapranov S. A., Khachaturov A. A. CHrespechenochnoe ehndobiliarnoe vmeshatel'stvo [Transhepatic endobiliary intervention.] Almanac of the Institute of surgery named after A.V. Vishnevsky, 2008; 3: 3: 45-51.
  6. Karpachev A. A., Prokofiev V. A. maloinvazivnye metody lecheniya "bol'shie" holedoholitiaza. Uspekhi sovremennogo estestvoznaniya, [minimally Invasive treatment of "large" of choledocholithiasis. The success of modern science,] 2007: 2: 69 to 76.
  7. Kotovsky A. E., Glebov K. G., Urzhumtsev G. A., Petrova N. And.EHndoskopicheskie tekhnologii v lechenii zabolevanij gepatopankreatoduodenal'noj zony. Annaly hirurgicheskoj gepatologii, [Endoscopic techniques in the treatment of diseases of hepatopancreatoduodenal zone. The annals of surgical Hepatology,] 2010; 15: 1: 9-18.
  8. About Hunters.And., In Lazarenko.And., Grigoriev S. N., Yakovleva M. V. intervencionnaya radiologiya v lechenii holedoholitiaza, oslozhnennogo mekhanicheskoj zheltuhoj.. Kurskij nauchno-prakticheskij Vestnik "chelovek i ego zdorov'e" [interventional radiology in the treatment of choledocholithiasis complicated by mechanical jaundice.. Kurskiy scientifically-practical Herald "Persons and his health",] 2011; 3: 115-121.
  9. Perepech N. B., Ryabov S. I. Kardiologiya. Rukovodstvo dlya vrachej. [Cardiology. A guide for physicians.] Spetslit. 2008; 1: 607.
  10. Prudkov M. I. osnovy maloinvazivnoj hirurgii.. Rukovodstvo dlya vrachej. Ekaterinburg [fundamentals of minimally invasive surgery.. a Guide for physicians. Ekaterinburg] 2007,. 200.
  11. Chen S., Huang M., Yang et al.Pereocenka chreskozhnaya
  12. v cholangioscopic chrespechenochnaya litotomii dlya pervichnoj hepatolithiasis. [Reappraisal of percutaneous
  13. the transhepatic cholangioscopic lithotomy for primary hepatolithiasis.] Surg. Endosc., 2005; 19(4): 505-509.
  14. Garg P. K., Tandon R. K. Ahuja V., Makharia GK, Batra Y. prediktory neudachnoj mekhanicheskoj litotripsii i ehndoskopicheskoj oformleniya krupnyh zhelchnyh protokov kamnyami. [predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones.[ Gastrointest Endosc., 2004; 59(6): 601-605.
  15. L. McHenry, Lehman G. slozhno zhelchnyh protokov kamnyami [difficult bile duct stones.] Gastroenterol., 200;9(2): 123-132.
  16. Ogawa K., Ohkubo H., S. Abe, Maerawa T. CHreskozhnaya chrespechenochnaya malokalibernogo choledochoscopic litotomiyu: bezopasnaya i ehffektivnaya metodika obshchego zhelchnogo protoka chreskozhnoe chrespechenochnoe razvedki vysokogo riska pozhilyh pacientov. Dzh Pancreat Gepatobiliarnoj Hirurgii [Percutaneous transhepatic small-caliber choledochoscopic a lithotomy: a safe and effective technique for common bile duct percutaneous transhepatic exploration of high-risk elderly patients.] J Hepatobiliary Pancreat Surg., 2002; 9(2): 213-217

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 ., ., ., ., .

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies