RESUMO
The peculiarities of endoscopic transpapillar interventions (ETPI) application in 630 patients, age from 11 to 94 years old with acute obstruction of common bile duct (CBD) were studied. In cases, when endoscopic biliary decompression was not possible, the biliary plastic stent or nasobiliary drain were used for prevention or treatment of cholangitis. In case of insufficiency of endoscopic treatment, 92 (14.6%) patients underwent biliary surgery; 37 (5.9% of them were operated laparoscopically.
Assuntos
Coledocostomia/métodos , Colestase/cirurgia , Ducto Colédoco/cirurgia , Gastroscopia , Laparoscopia , Sucção/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colestase/mortalidade , Colestase/patologia , Ducto Colédoco/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Resultado do TratamentoRESUMO
The results of endoscopic transpapillary surgical interventions in 115 patients, suffering choledocholithiasis, caused by the multiple calculi presence, were analyzed. The patients were divided on four groups, depending on the treatment provided. In 78 patients (first group) endoscopic papillosphincterotomy with mechanical lithoextraction in conjunction with spasmolytic and infusion therapy were performed. In 16 patients (second group) endoscopic papillosphincterotomy with mechanical lithotripsy and partial lithoextraction, endobiliary stenting with further spasmolytic and infusion therapy were performed. In 11 patients (the third group) endoscopic papillosphincterotomy, mechanical lithotripsy with a partial lithoextraction and nasobiliary drainage were used. In 10 patients (the fourth group) endoscopic papillosphincterotomy, mechanical lithotripsy, nasobiliary drainage and endobiliary stenting were applied. The best results were achieved in the first group: the smallest duration of the operation--(32.2 +/- 12.6) min, the smallest stationary state duration--(3.3 +/- 1.2) days, the lowest rate of intraoperative complications--2.6%.
Assuntos
Coledocolitíase/cirurgia , Ducto Colédoco/cirurgia , Duodenoscopia/métodos , Cálculos Biliares/cirurgia , Adulto , Idoso , Coledocolitíase/patologia , Coledocolitíase/terapia , Ducto Colédoco/patologia , Drenagem , Duodenoscopia/efeitos adversos , Feminino , Hidratação , Cálculos Biliares/patologia , Cálculos Biliares/terapia , Humanos , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/prevenção & controle , Intubação Gastrointestinal , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Parassimpatolíticos/administração & dosagem , Parassimpatolíticos/uso terapêutico , Esfinterotomia Endoscópica/efeitos adversos , Esfinterotomia Endoscópica/métodos , StentsRESUMO
The results of examination and treatment of 746 patients, suffering obturation jaundice of various origin, were analyzed. A diagnosis-treatment algorithm for obturation jaundice was elaborated. Two-staged treatment was conducted in the patients: endoscopic decompression of a bile diverting pathways for normalization of the hepatobiliary system organs function and operative intervention, using miniinvasive technologies. Introduction of the surgical tactics elaborated for a staged and rational conduction of a bile restoration operations with application of miniinvasive technologies have permitted to lower significantly the postoperative complications rate down to 7.5% and postoperative lethality--to 0.8%.
