ABSTRACT
Analysis of clinical material of 206 patients with tumor obstruction of the distal part of the common bile duct allowed the conclusion to be made on the expediency of applying endoscopic methods for jaundice correction as the first stage in preparation for the operation (122 patients) and also as the only and final operation (70 patients). Study of the immediate and late-term results of different variants of operations for bile diversion in obstruction of the distal choledochus (203 operations) showed the superiority of the Roux hepaticoejunoanastomosis in which recurrent jaundice due to obstruction of the cystic duct does not occur, as is encountered in creation of a cholecystoejunoanastomosis, and there are no conditions for the development of ascending cholangitis.
Subject(s)
Biliopancreatic Diversion/methods , Cholestasis, Extrahepatic/surgery , Adult , Aged , Aged, 80 and over , Cholestasis, Extrahepatic/etiology , Common Bile Duct Neoplasms/complications , Female , Humans , Laparoscopy , Male , Middle Aged , Treatment OutcomeSubject(s)
Ampulla of Vater/surgery , Common Bile Duct Diseases/surgery , Postoperative Complications/etiology , Sphincterotomy, Transduodenal/methods , Aged , Endoscopy, Digestive System/methods , Humans , Intraoperative Care , Middle Aged , Postoperative Complications/mortality , Sphincterotomy, Transduodenal/adverse effectsABSTRACT
The authors examined 81 patients who were subjected to endoscopic papillosphincterotomy (EPST) in the management of acute cholecystitis attended by total or partial obstruction of the choledochus. Cholestomy was carried out before or after EPST in 68 patients but not in 13 patients. The duration of the follow-up period after treatment ranges from 12 months to 6 years. All patients who were examined felt well and had no complaints caused by cholelithiasis. It was found that destruction of the sphincter apparatus of the major duodenal papilla and terminal choledochus led to the development of reflux from the duodenum into the choledochus in 25% of cases. In 18 patients ultrasonic examination revealed signs of chronic pancreatitis which was not manifested clinically. Among 13 patients with a preserved gallbladder containing concrements only 3 were operated on during the follow-up period. Residual choledocholithiasis was found in 5 patients in whom during good bile drainage after EPST it was not manifested clinically. The authors come to the conclusion that EPST shows a high clinical efficacy in the treatment of acute cholecystitis complicated by obstruction of the terminal choledochus.
Subject(s)
Ampulla of Vater/surgery , Cholecystitis/surgery , Endoscopy , Sphincter of Oddi/surgery , Acute Disease , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Time FactorsABSTRACT
The authors analyse the results of treatment of 255 patients with obstructive jaundice of nonneoplastic origin. Various endoscopic methods were used. Endoscopic interventions were carried out in the first two days in 79.8% of cases. Laparoscopic cholecystostomy was conducted in 138 patients; jaundice was relieved in 3 to 20 days in 95% of cases. It is shown that the best results of operative treatment of patients with acute cholecystitis complicated by choledocholithiasis are produced in concurrent use of laparoscopic cholecystostomy and endoscopic papillosphincterotomy.
Subject(s)
Cholestasis, Extrahepatic/surgery , Cholestasis, Intrahepatic/surgery , Gallstones/surgery , Acute Disease , Aged , Cholangiopancreatography, Endoscopic Retrograde , Cholecystitis/complications , Cholestasis, Extrahepatic/diagnosis , Cholestasis, Extrahepatic/etiology , Cholestasis, Intrahepatic/diagnosis , Cholestasis, Intrahepatic/etiology , Gallstones/diagnosis , Gallstones/etiology , Humans , Laparoscopy , Middle Aged , Pancreatitis/complicationsABSTRACT
Urgent laparoscopies were performed on 566 elderly and senile patients suspected of acute surgical diseases of abdominal organs. Laparoscopic examinations proved to be highly informative in 90.4%, little informative in 6.6%, erroneous in 3% of cases. Wide use of urgent laparoscopies in elderly and senile patients allowed to avoid laparotomies in 62.3% of the cases. High curative-diagnostic efficiency of laparoscopies added by laparoscopic cholecystostomy and antegrade cholecystocholangiography in patients with acute cholecystitis, cholecystopancreatitis, mechanical jaundice has been shown.
Subject(s)
Abdomen, Acute/diagnosis , Digestive System Diseases/diagnosis , Abdomen, Acute/surgery , Age Factors , Aged , Digestive System Diseases/surgery , Emergencies , False Negative Reactions , Female , Humans , Laparoscopy , Male , Middle AgedSubject(s)
Catheterization/methods , Cholecystitis/surgery , Cholecystostomy/methods , Acute Disease , Humans , Laparoscopy , Suture TechniquesSubject(s)
Appendicitis/diagnosis , Acute Disease , Adolescent , Adult , Aged , Female , Humans , Laparoscopy , Male , Middle AgedSubject(s)
Cholecystitis/complications , Gallstones/complications , Acute Disease , Adult , Aged , Female , Humans , Male , Middle AgedSubject(s)
Abdomen, Acute/diagnosis , Laparoscopy , Abdomen, Acute/surgery , Adolescent , Adult , Aged , Emergencies , Female , Humans , Male , Middle Aged , Preoperative CareSubject(s)
Biopsy, Needle , Pleura/pathology , Pleurisy/pathology , Adult , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Pleurisy/etiologySubject(s)
Bronchi , Middle Lobe Syndrome/diagnosis , Adolescent , Adult , Aged , Biopsy , Bronchography , Bronchoscopy , Catheterization , Diagnosis, Differential , Humans , Middle Aged , PuncturesABSTRACT
The materials concerning 19 patients with pleural mesotheliomas are analysed. The patients were subdivided into three groups according to the clinico-roentgenological picture and course of the affection: 1) four patients in whom pleural mesothelioma proceeded without exudate accumulation; 2) seven patients in whom exudate accumulation in the pleural cavity was the main sign of the tumor; 3) 8 subjects in whom the tumor developed on the side of an artificial pneumothorax many years following its cessation. Among 19 patients only in 5 cases the tumor was suspected soon after their admission to the hospital. A needle biopsy of the pleura is felt to be the most effective method of diagnosis of pleural mesotheliomas, whereas in failure of the former -- pleuroscopy.
