METHOD OF INTERNAL DIVERSION OF BILE IN DISTAL TUMOR OBSTRUCTION OF THE BILIARY TRACT
A.Z.ABDULLAEVA, R.T.MAJIDOV, E.P.MAMEDOVA
Dagestan State Medical Academy, Makhachkala, , RUSSIA
Purpose. Evaluation of the effectiveness of internal drainage of biliary tract with its distal obstruction with the coverage of the orifice of cystic duct.
Materials and methods. For the period from 2005 to 2009, 24 patients (13 men and 11 women) were performed internal diversion of bile through the formation of hepaticocholedocholecystoanastomosis on “frame” drainage with the withdrawal of the end of the drainage to the anterior abdominal wall in the form of contact cholecystostomy and cholecystoduodenostomy for the mechanical jaundice because of periampular tumor.
The indications for this kind of internal diversion of bile included: nonfunctioning gallbladder due to invasions of orifice cystic duct by tumour process; inability to perform radical surgery for locally advanced tumour, or impossibility of radical operation because of locally spread tumor process, or presence of distant metastases; the presence of severe comorbidity and old age a patient. “Frame” drainage was removed on 8-9th days after the resolution of cholestasis, performance of drainage cholegraphy and satisfactory passage of contrast into the duodenum.
In postoperative period, all patients were intravenously injected Reamberin 400.0 ml 1 time\day, 5.0 ml of essentiale 1 time a day and 100 mg of Tanerit 2 times a day for the prevention of the syndrome of “rapid decompression” of biliary tract
Results. No failure of biliobiliary and biliodigestive anastomoses was observed. Syndrome of “rapid decompression” of the biliary tract was observed in 2 (8.3%) patients. In all cases there was reached resolution of cholestasis. In the closest postoperative period, recurrence of jaundice constituted 0%, 30 - day mortality - 4.1%, average duration of life of patients after intravenous diversion of bile for locally spread periampular tumour process, was 183 days.
Conclusions. The use of the gallbladder as a “mediator” for internal diversion of bile in the distal tumor obstructions of the biliary tract, with the involvement of the orifice of the cystic duct into the pathologic process, is the method of choice in case of unresectable periampular tumours.
DYNAMICS OF INDICATORS OF LIPID PEROXIDATION AGAINST THE BACKGROUND OF A DIFFERENT TREATMENT APPLIED IN THE POST-OPERATIVE PERIOD IN PATIENTS WITH MECHANIC JAUNDICE OF CHOLELITHIC ETIOLOGY
Scientific and Surgical Center named after M.A.Topchubashov, Baku, AZERBAIJAN
The study was carried out on 80 patients admitted to the hospital with the diagnosis of chronic calculous cholecystitis, choledocholitiasis and mechanic jaundice. The studied patients were divided into 3 groups. 1st group - 20 patients, treated by traditional, conventional methods; 2nd group - 30 patients, that were applied “Hepa –merc” drug in addition to traditional basic therapy; III (main) group - 30 patients, whose traditional complex therapy was added N-acetylsystane. Dynamics of indicators of LPO and alphatocopherol in these groups.
As in the 1st group, products of leukocyte peroxidation were at high level in the 2nd group at the moment of their admission to the hospital; against the background of the conducted complex treatment, on the 7th day of therapy, Dien conjugates has decreased by 0, 04 D233/ml, Schiff base - by 5,7 unit/ml.mg, TBt active products- by 0,6 mmol/l, and alpha-tocopherol increased by 16,3 mkg/ml/mg. In patients with MJ of cholelithic etiology, significant decrease of the level of dien conjugates (p<0,05) was possible on the 10th day of single treatment, and decrease of Schiff base and Tbt – active products was possible on 7-10th days: If at the moment of admission Dien conjugates constituted 0,65 D233/ml, then on the 7th day of treatment the figure decreased by 34% an constituted 0,43 D233/ml, and on the 10th day of treatment it was 2.8 times less than the initial indicator, and constituted - 0,23 D233/ml. In these patients, on the 7th day Schiff base was 2.2 times, and on the 10th day – 2.8 times less than the initial indicator. The level of TBt –active products, on the 7th day was 2.5 times and on the 10th day – 2.8 times less than initial indicator. Identification of N-acetylsystane had positive influence on alpha- tocopherol: thus, on the 7th day of treatment, the level was 1.8 times, and on the 10th day 2 times higher as compared to the initial indicator.