S.N. KHUNAFIN, AA. NURMUKHAMETOV, I.KH. GATTAROV, A.SH. ZAGRETDINOV,
D.R. AKHMEROV, N.R. YUSHKOV, R.S. NURGALIN, A.F. BIKMETOV
Bashkiria Medical University, City Clinical Hospital N 18, Ufa, RUSSIA
The aim of the study was to improve the diagnosis and results of surgical treatment of patients with biliobiliary fistulas.
Materials and methods. We analyzed the results of treatment of 27 women with biliobiliary fistulas treated in the SCH for the last 25 years. 23 patients were hospitalized in a matter of urgency, 4 – in the planned order. In the majority of cases (18) there was observed the clinic of acute cholecystitis or cholecystopancreatitis, accompanied by temperature rise, chill, expressed pain syndrome. In 17 cases there was observed a picture of obstructive jaundice, in 11 of them with the clinic of cholangitis. In 8 patients infiltrate in the right upper hypochondrium was clearly palpable. The level of total bilirubin ranged from 28.6 to 248 micromole/liter.
Examination was conducted with the application of: ultrasound, intravenous cholecystocholangiography, endoscopic retrograde cholangiopancreatography-ERPCG, percutaneous cholangiography, transhepatic-THCG. Before the operation, presence of biliobiliary fistula was determined only in 4 of 27 patients: in 2 patients by ERPCG method; in 1 based on cholecystocholangiography and in another one patient – it was suspected based on clinical and anamnestic data.
Results and discussions. Urgent operations were performed in 18 patients, delayed - in 3, scheduled - in 6 patients. In 14 cases chronic changes in the gall bladder and 13 cases phlegmonous - gangrenous cholecystitis was observed.
All patients underwent cholecystectomy. In 21 cases, removal of the gallbladder was combined with choledochotomy, 2 of them were performed internal drainage, 16 patients were inserted external drainage of common bile duct (by Keruen 5, A.V. Vishnevski 6, Pikovsky 2 transhepatic drainage of the right bile duct according to Pradera - Smith 1 , right and left hepatic ducts in 2 patients). Reconstructive surgeries were performed in 2 patients. 5 operations were performed with the use of minilaparotomy access by Prudkova method. In 2 of 27 operated patients, a large choledochal defect was removed due to a pelvis of gallbladder, and in 5 - the operation was completed on a T-drainage.
6 (22.2%) of the 27 operated patients died. The direct cause of death in 5 patients was a hepatic - renal failure, in one case – non-arrested peritonitis.
Date: 2014-12-28; view: 788