RELEVANCE OF TRADITIONAL SURGERY IN THE SURGICAL TREATMENT OF COMPLICATED CHOLEDOCHOLITHIASIS
Abstract
Choledocholithiasis in the structure of cholelithiasis occurs in 10–35% of patients and contributes to the development of severe complications such as mechanical jaundice, cholangitis, acute pancreatitis. The majority of leading domestic and foreign specialists nowadays consider the main endoscopic method in surgical treatment of choledocholithiasis, which allows to provide patency of bile duct and large duodenal papilla, to perform removal of concrements, to sanitize biliary tracts, and if necessary to provide decompression of biliary tree by external or internal drains. In case of complicated choledocholithiasis the insistence to extract the concrements from the choledochus by endoscopic method significantly increases the probability of intraoperative and postoperative complications (cholecystitis, cholangitis, bleeding from the area of dissection, perforation of the duodenal wall, acute pancreatitis), the frequency of which increases up to 20% and lethality reaches 10%. The choice of surgical tactics for treatment of this complex group of patients remains an open question.
References
Гальперин Э.И., Ветшев П.С. Руководство по хирургии желчных путей. М.: Видар; 2009.
Ермолов А.С. Хирургия желчнокаменной болезни. Анналы хирургии. 1998;3:13–24.
Михин А.И. и др. Эндоскопическое лечение пациентов старческого возраста со сложным холедохолитиазом. Эндоскопическая хирургия. 2019; 25(1):53–60.
Мумладзе Р.Б., Чечерин Г.М., Баранов Ю.В. Мини-инвазивные технологии хирургического лечения острого холецистита и механической желтухи у больных пожилого и старческого возраста. Клиническая геронтология. 2008;4:17–21.
Охотников О.И., Григорьев С.Н., Яковлева М.В. Транспапиллярные миниинвазивные вмешательства при холедохолитиазе. Анналы хирургической гепатологии. 2011;16(1):58–62.
Шаповальянц С.Г. и др. Сложный холедохолитиаз – результат запоздалого хирургического лечения желчнокаменной болезни. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2013;4:8–14.
McHenry L., Lehman G. Difficult bile duct stones. Curr Treat Options Gastroenterol. 2006;9(2):123–132.
Molvar C., Glaenzer B. Choledocholithiasis: Evaluation, treatment, and outcomes. Semin Intervent Radiol. 2016;33(4):268–276.
