IATROGENIC INJURY OF BILE DUCTS

Z.T.SHIRINOV, F.S.IDRISOV, Z.N.AZADOVA

Scientific Centre of Surgery named after M.A. Topchubashev, Baku, AZERBAIJAN

Iatrogenic lesions of bile duct occurs in open and laparascopic cholecystectomies (LCE) in 90% of cases, and during echinococcetomy (EE) in 10% of cases and during other operations.

In 2006-2011 25 patients with iatrogenic injuries of bile ducts were performed repeated reconstructive operation in the SSC named after M.A.Topchubashov. Patients were at the age of 22 – 78 years, 9 (36%) men, 16 (64%) women. The majority of patients were performed operations at stateand private hospitals in different countries and cities of the Azerbaijan Republic, of Baku city. All the patients were performed ltrasound, CT, NMR-CT+Cholangiography, VFEGDS, ERXPG, interoperational cholangiography and laboratory examinations.

4 (16%) patients had bile fistula after hepatic EE. Because of bile peritonitis in one patient there was performed relaparatomy, 1 patient was performed relaparatomy and suturing of fistula because of bile peritonitis, 2 bile fistula and mechanical jaundice was performed relaparatomy, inspection of the residual cavity, cholidochotoomy, cleaning of chitinous membranes and insertion of CDA, in 1 patient operation for the removal of formed bile fistula 1 year after operation.

3 (12%) patients were performed poliative operation for mechanical jaundice against the background of oncologic diseases.

In 8 (32%) patients 1 week – 1 year after cholesistectomy there was performed choledocholitisis, and mechanical jaundice diagnosis was confirmed. The patients were performed relaparatomy, choledocholitotomy (there were removed 2-51 stones with0,5-2,5 sm diameter ), 4 patients were performed choledochostomy by Kerr method, 4 patients were performed CDA operation.

9 (36%) patients had open, 1 (4%) patients yatrogen injuries during LCE. In 5 (20%) of them there was performed ligation of the loop because of bleeding during the operation – mechanical jaundice, in 3 (12%) patients – removal of choledoch jointly with gallbladder (2 patients opern, 1 patient LCE), development of bile peritonitis. The injuries were of II type according to H.Bismuth classification in 5 (20%) patients, in 3 (12%) patients there were observed the III-IV types. In 3 (12%) of patients there was performed hepaticoyeyunostomy with Roux loop without drainage, in 5 (20%) of patients hepaticojejunostomy with Roux loop on drainage, 1 (4%) patients restoration of right duct on Kerr drainage because of the injury of right hepatic duct, in 1 (4%) of patients during cholecystectomy, transduodenal papillosphyncteromy posterior wall of duodenum was inured, there formed anaerob absess of retroperitoneal area,the patients was performed opening and drainaje of the absess cavity, further, there were performed operations of gastroenteroanastomotic insertion with relaparotomy Roux loop.

MEDICAL AND ECONOMIC EFFECTIVENESS OF CHOLECYSTECTOMY OPERATION BY VARIOUS METHODS

Z.T.SHIRINOV, F.S.IDRISOV

Scientific Centre of Surgery named after M.A. Topchubashev, Baku, AZERBAIJAN

Cholelithiasis and its complications take a serious place among liver and biliary tracts diseases. Removal of the gallbladder – cholecystectomy is considered to be an operation of choice during inflammation of the gallbladder and other diseases. Hundreds of such operations are performed throughout the world within a year. It is more than hundred years that during cholecystectomy resection is carried out by Cocher method or Feodorof improvement resection. The use of laparascopic cholecystectomy – have started first in Germany with the application of miniinvasive technology, then in France, USA and Russian federation. At present it is used in the world, as well as in the Azerbaijan Republic as a “gold standard”. The “mini” resection cholecystectomy offered by Prudkov in 90s of the last century began to be widely applied.

Results of 500 patients exposed to cholecystectomy at the hepatic, biliary and MAV surgery at the SSC named after M.A.Topchubashov within 2006-2011 were studied. The patients were divided into 3 random groups. The 1^st group were performed open – traditional cholecystectomy – 200 (40%) patients, 2^nd group – laparascopic cholecystectomy – 200 (40%) patients and 3^rd group - “mini” resection open cholecystectomy operation - 100 (20%) patients. To assess medical and economic effect of cholecystectomy in patients of all the three groups, the following indicators were studied: intraoperational complications, immediate post operational complications, duration of the operation (according to narcosis card); type of anaesthesia (narcosis) and used medical preparations; need in additional expensive videolaparascopic devices during the operation (opening, inspection biliary tracts, biliodigestive operations); conversion - transition to open operation; type and effectiveness of post-operative analgesia; total cost of the operation (according to the pricelist of one of the private clinics); cosmetic effect, temporary lost of labor activity (number of bed days); duration of rehabilitation; occurrence of recurrences and complications in long-term post operative period;

According to the study and comparative assessment of all the indicators for patients of all the three groups, “mini” resection open cholecystectomy is the method with the highest medical and economic effect. On the 2^nd place there is laparascopic cholecystectomy, on the 3^rd place- open – traditional cholecystectomy.

Date: 2014-12-28; view: 856