INTERNAL DRAINAGE OF LIVER FIBROUS CAVITY OF LIVER AFTER ECHINOCOCCECTOMY

R.T.MAJIDOV, R.S.SULTANOVA, SH.R. MAJIDOV

RMS GV, Makhachkala, RUSSIA

The aim of the study. To evaluate possibilities and clarify the indications for internal drainage of fibrous cavity of liver after the removal of hepatic hydatid cyst in the 3^rd phase of life.

Materials and methods. Over the past decade we examined 669 patients with hydatid disease of liver. In 103 (15.4%) cases, central localization of medium and large hydatid cysts in 3 phase of life were observed. In all cases, after echinococcectomy cystobiliary fistulas and in 32 (31.1%) cases calcification of the fibrous capsule were observed. Echinococcectomy operation from the liver in 71 (68.9%) cases was completed by external drainage of residual cavity, and in 32 (31.1%) - internal drainage by the formation of cystodigestive anastomosis with disconnected small intestine loop along Roux. The length of the disconnected loop was more than 60 cm for the prevention of reflux cholangitis. Formation variant of cystodigestive anastomosis depended on the location of the cyst (left or right portion of the liver), projection of the cyst over the visceral or diaphragmatic surfaces of the liver.

Results. Intraoperative complications in the compared groups were not observed. The median of the duration of surgery in the control group was 91,6 ± 7,8 min. in the main 122,4 ± 6,5 min. Postoperative complications in the control group of patients were observed in 15.6% of cases, mainly, of purulent-inflammatory nature, and in the main - in 6.2% of patients (signs of cholangitis). The failure of anastomoses was not observed. The median of the total period of hospitalization of patients in the main group constituted 12,2 ± 1,6 bed-days, in the control group - 22,4 ± 2,1 bed-days. The median of the duration of stay of the drainage in the fibrous cavity with outer outflow of bile in the control group of patients constituted 42,6 ± 6,5 days. 26 (36.1%) patients of the control group were rehospitalized for correction of dyscrasia. No deaths were observed in the compared groups.

Conclusion. In the residual cavities with multiple cystobiliary fistulas and calcification of fibrous capsule internal drainage of the cavity by the formation of cystodigestive anastomosis was the best option for the completion of echinococcectomy of liver fibrosis.

ULTRASOUND – DIAGNOSTICS OF THE LEVEL OF BILIARY TRACT OCCLUSION

R.T. MAJIDOV, Z.R. KHABIBULAEVA, A.I. GAJAKAEVA

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

Makhachkala, RUSSIA

Introduction. Subject to the level of the tumor block of bile ducts, there are proximal, central and distal biliary tract obstructions.

The aim of the investigation. Determination of the level of biliary tract occlusion.

Materials and methods. We have analyzed data of ultrasound of hepatopancreatoduodenal zone of tumor lesion of biliary tract in 90 patients. Bile duct cancer was diagnosed in 22 (24.7%), cancer of head of pancreas - 42 (46.6%), cancer of Vater's papilla - 12 (13.3%) and metastatic biliary duct obstruction - 14 (15.7%) patients.

Results. During the localization of the process at the level of the porta hepatis (proximal obstruction) extension of only intrahepatic bile ducts was observed. Fallen gall bladder, absence of liquid in the bladder lumen; hyperechoic contents of the bladder, absence of choledochal dilatation, normal sizes of the pancreatic head are characteristic for this type of obstruction. In case of cancer of porta hepatis in the fusion zone of lobar hepatic ducts, space-occupying lesion of heterogeneous echostructure with uneven contours of different sizes was found. Tumors of extrahepatic bile ducts were presented as hyperechoic structures of various sizes connected with the wall of the ducts with uneven contours, exophytic or pericholedochal growth. The gall bladder in the form of hypo-or hyperechoic formation, with uneven, unclear contours; and little or no fluid in the lumen of the bladder; near the gallbladder in liver parenchyma hyperechoic formations are found; above the fusion area of the cystic duct, bile ducts are dilated; choledoch is either unchanged, or not visualized; possible concrements in the lumen of the bladder are characteristic for tumors of the gallbladder with invasion of ducts (central obstruction). In case of hepaticocholedochal tumor and tumor of supraduodenal portion of choledoch, above the zone of the stricture, dilated bile ducts and fallen gall bladder were found. Dilation of biliary tract, beginning with supraduodenal portion of choledoch; large gall bladder, hyperechogenic formations in the terminal section of choledoch, either in the head of the pancreas or in the lumen of the duodenum are characteristic for distal obstruction. Sensitivity of ultrasound for the diagnosis of biliary tract obstruction constitutes 95.6%.

Conclusion. Ultrasound of hepatopancreatoduodenal zone allows to determine the level of occlusion of the biliary tract during its tumor process.

Date: 2014-12-28; view: 976