FEATURES OF SURGICAL TACTICS DURING THE BREAK OF ECHINOCOCCUS CYST INTO THE BILIARY TRACT

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

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

Makhachkala, RUSSIA

Introduction. Serious complication of echinococcosis of the liver is a break of the cyst into biliary tract with the development of obstructive jaundice, cholangitis and, in some cases, pancreatitis. Selection of a rational surgical tactics in this situation is of great practical interest.

The aim of the study. To evaluate the effectiveness of the external-internal drainage of the biliary tract at the break of the echinococcus cyst of liver intp the biliary tract.

Materials and methods. Own experience in treatment of 57 patients with the break of echinococcus cyst of the liver into the biliary tract was summarized. Monocystic echinococcosis was observed in 49 (85.9%) patients, and multiple echinococcosis of liver - in 8 (14.1%) patients. In all cases there was observed central location of the cyst broken into the biliary tract. Obstructive jaundice was observed in all patients, cholangitis on the background of jaundice were observed in 23 (40.3%) patients, pancreatitis - in 6 (10.5%). In case of multiple echinococcosis the break into biliary tract was observed only in one cyst. The attempt to drain the biliary tract external by a percutaneous transhepatic puncture under X-ray control was undertaken in 3 observations. ERCPG with further EPST was performed two patients. All 57 patients were performed laparotomy, open echinococcectomy from the liver with external drainage of residual cavity; supraduodenal choledochotomy with the lavage of the biliary tract with ozonized physiological solution and choledochoduodenostomy.

Results. In cases of percutaneous transhepatic puncture of the biliary tract its decompression was not adequately achieved due to the impossibility to extract embryonic elements of a parasitic cyst from the bile ducts. After the echinococcectomy, external-internal drainage of the biliary tract recovery was observed in all cases. Cholestasis and cholangitis, if there is, were resolved on the 5-6^th days, discharge through the drainage tube stopped on the 3-4^th days. Intra-and postoperative complications were not observed. Duration of inpatient treatment constituted 14.6 ± 2.3 bed days, duration of the stay of drainage tube in the residual cavity – 17.3 ± 3.1 days. No fatal outcomes were observed.

Conclusion. Our experience shows that the external-internal drainage of the biliary tract after the echinococcectomy in case of break of the cyst into the biliary tract provides complete recovery of patients in the shortest terms.

SURGICAL APPROACH IN CLATSKIN TUMOR

R.T. MAJIDOV, A.Z. ABDULLAYEVA, Kh. A. ABDURASHIDOV

Daghestan State Medical Academy, Makhachkala, RUSSIA

Background: Malignant tumors of bile ducts in the porta hepatis, including Clatskin tumor constitute a complex problem of biliary surgery. Without treatment, most patients with hilus cancer of bile ducts die within 5-6 months after diagnosis.

The aim of the study: To evaluate effectiveness of two-step treatment approach in Clatskin type tumors.

Materials and methods: We have analyzed immediate results of a two-stage treatment in 23 patients (13 women and 10 men) with Clatskin type tumor. The average age constituted 59,3 ± 1,5 years. At the first stage, all patients were performed percutaneous transhepatic biliary tract decompression: external – 15 patients (65.2%), external-internal - 8 (34.8%). Metastases into liver were detected in 4 (17.3%) patients. Radical surgical interventions after the improvement of the condition of patients and resolution of cholestasis were performed in 16 (69.5%) patients. Other patients (7 men) were not performed repeated surgical interventions because of the prevalence of cancer.

Results and their discussion: Technical success biliary tract decompression by minimally invasive method in Clatskin tumor was observed in 100% of cases. The most adequate drainage of the biliary tract was reached in percutaneous transhepatic external-internal procedures. Resolution of obstructive jaundice and the absence of local spread of tumor and distant metastases allowed to perform radical surgery in 16 patients: sparing liver resection "Taj Mahal resection" a bifurcation resection of bile ducts. In patients with unresectable tumor lesion percutaneous transhepatic biliary tract decompression provides long-term remission of jaundice and the possibility of chemotherapy. The combination of adequate decompression of the biliary tract and chemotherapy in 7 patients lead to the increase in median of survival up to 16.7 months.

Conclusions: In Clatskin tumor there are relatively more opportunities to perform radical surgery. A two-stage approach allows better preparation of patients for the operation and to perform them without complications.

Date: 2014-12-28; view: 889