ANALYSIS OF RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH INJURIES OF MAIN BILE DUCTS
DOI:
https://doi.org/10.11603/1811-2471.2018.v0.i1.8721Keywords:
cholecystectomy, bile duct damage.Abstract
We observe the increasing amount of patients with pathology of bile ducts last decades, both in Uzbekistan and in many others countries. Also, the quantity of surgical interventions on bile ducts has been mainly raised. As a consequence, the frequency of bile ducts traumas increased significantly also in 2–4 times, from 0.22 up to 1.86 %. Wide implementation of laparoscopic cholecystectomy also finalized in increased amount of frequency and severity of bile duct damage. The average incidence of bile ducts traumas is 0.5–1%. It means that every year 50–100 persons suffer from such complication in Uzbekistan.
The aim of the study – to optimize the surgical treatment of “fresh” injuries of main bile ducts.
Material and Methods. The results of surgical treatment of 42 patients with injuries of main bile ducts in period of 2006–2016 years were analyzed. Such complication were diagnosed in 26 patients (0.88 %) among 2947 cholecystectomies (ChE). 17 patients got injuries of main bile ducts after laparotomy cholecystectomies (LChE); 6 – after minilaparotomy cholecystectomies (MLChE); 3 – after traditional ChE (TChE). 16 patients were admitted from the other hospitals with “fresh” injuries of main bile ducts: 3 of them after LChE, 12 – TchE and 1 – after MLChE. In 11 (26.2 %) patients the injuries were diagnosed during the surgical intervention, in the vast majority of patients 31 (73.8 %) – at the early post-operational period. There were 33 women (78.6 %) and 9 men (21.4 %); the age of patients from 19 among to 80 years old. The estimation of injuries’ severity was performed by E. I. Halperin classification.
Results and Discussion. One- and two-stage interventions were performed, depending on the presence of infiltra- tive-inflammatory changes in the subhepatic region, when bile duct lesions were detected in the early postoperative period (n = 31),
For 12 patients with mechanical jaundice and without the inflammation and infiltration processes the one-stage surgical interventions were performed. The operation of choice is the hepatic jejuno-anastomosis according to Roux- en-Y. It was done for 14 patients with good long-term result by 85.7 %. The rate of complications in early postoperative period was 26.2 %, long-term – 35.7 %. Lethality rate was 4.7 %. Operations with formation of anastomosis of damaged duct with duodenum had negative consequences of treatment. Chronic cholangitis and anastomosis narrowing was observed, what required endoscopic intervention in 5 patients.
Conclusions. The main reasons for failures in the treatment of "fresh" injuries of main bile ducts are the untimely diagnosis and the performance of inadequate volume of surgical interventions to restore the flow of bile creating the biliobiliary and bilioduodenal anastomoses.
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