SELECTION OF THE METHOD OF RECONSTRUCTION OF THE BILIARY TRACT WITH HIGH STRICTURES AND "FRESH" BILE DUCT INJURIES

R.T. MAJIDOV, A.I. GAJAKAEVA, A.Z.ABDULLAYEVA, Z.R.KHABIBULAYEVA

Clinic of General Surgery of SEI of HPE, Dagestan State Medical Academy

Makhachkala, RUSSIA

Introduction. Bile duct stricture and their iatrogenic injury in the confluence region and higher is a quite difficult problem both in terms of restoration of the passage of bile into the intestine and in the prophylaxis of restenosises.

The aim of the study. To evaluate the effectiveness of various options of biliary tract reconstruction after the resection of tumors of hilus localization, high bile duct strictures and ‘fresh” high bile duct injuries.

Materials and methods. 84 reconstructive interventions on the bile duct were performed over the past 10 years in the clinic of general surgery of SEI of HPE “Dagestan State Medical Academy of Roszdrav”. There were 38 men and 46 women at age of 26-76.

Results. In the closest postoperative, complications were observed in 16.6% of observations. Unacceptable results during the isolation of the biliary-enteric anastomosis under the conditions of arrosive hemorrhage in the area of ​​anastomosis were observed in 2 (2.5%) patients, one of whom died. Postoperative mortality among all patients constituted 3.6%. In the late postoperative period stenosis of biliary-enteric anastomosises was observed in 13 (15.7%) patients. In four cases, there was performed repeated reconstruction of the biliary tract, and in 9 observations - mini invasive percutaneous transhepatic interventions.

Conclusion. In 37 (44.0%) patients there were found post-traumatic cicatricial strictures, in 92% of cases the underlying cause of cicatrical obstruction of ducts was iatrogenic injury. In 5 (5.9%) cases reconstruction of the biliary tract was performed during fresh iatrogenic injuries. 42 (50.1%) patients had a neoplastic process. According to the classification of E.I. Galperin and H. Bismuth there were identified the following types of this disease: type “+2” -17, type “+1” -20; type 0-22, type “-1” -16; type “-2” -6; type “-3” -3. The diagnosis included ultrasound, CT, MRT and ERCPG. Percutaneous transhepatic biliary tract decompression was performed in 52 (61.9%) cases. In 4 (4.7%) cases there was formed a quadrihepaticojejunoanastomosis on silicon stents, 8 (9.3%) – tetrahepaticojejunoanastomosis on “framehouse” drainage, and in 35 (41.6%) - bihepaticojejunoanastomosis to “framehouse” drainages and 37 (44.0%) cases - hepaticojejunoanastomosis. The length of small intestine along the Roux loop ranged between 80-90 cm.

Date: 2014-12-28; view: 953