Abstract: Aim: was to assess the possibility of x-ray surgical recovering of the integrity of the upper urinary tract in the absence of dilatation of kidney collecting system. Material and methods: for the period of 2018-2020, under our supervision there were 9 patients with an unexpanded kidney collecting system against the background of the existing external or internal urinary fistula. In 6 patients after cystoprostatectomy and ureteroenterocutaneostomy (Bricker surgery), a migration of urethral drainage occurred. In 3 cases, after gynecological operations, patients were diagnosed with iatrogenic complete transverse ureter damage with the formation of retroperitoneal (intrapelvic) uroma. At the first stage in all 9 patients we performed percutaneous nephrostomy on unexpanded kidneys’ collecting system under ultrasound guidance using special techniques. To restore patency of the damaged ureter, a combined ante-retrograde approach was used. The antegrade flexible guidewire was moved through damaged (cut off) ureter, and retrograde through the entrance of damaged ureter or enterostomy with a capturing device, under x-ray control, the guidewire was brought out. Then, pyeloureteral drainage was placed in an adequate position of the enterocutaneostomy retrograde or antegrade, splinting the ureter damage zone. Results: in 6 patients, after Bricker surgery, the lost ureteral drainage was adequately restored. In patients with a cut off ureter, it was possible to restore the course of the damaged ureter on the external-internal pyelo-urethral drainage by closing the internal urinary fistula and eliminating retroperitoneal urine by percutaneous drainage under radiation control. There were no complications associated with the technique of x-ray surgery. Conclusion: percutaneous nephrostomy on an unexpanded kidney collecting system using special techniques for the verification of kidney collecting system is a potentially replicable safe technique that allows to perform in stages adequate external derivation of urine. Percutaneous nephrostomy can be used as a «bridge» technique for subsequent x-ray surgical interventions on the ureter, including with its complete iatrogenic damage.
References 1. Patel U, Hussain FF. Percutaneous nephrostomy of non-dilated renal collecting systems with fluoroscopic guidance: technique and results. Radiology. 2004 Oct; 233(1 ):226-233. https://doi.org/10.1148/radiol. 2331031342 2. Liu BX, Huang GL, Xie XH et al. Contrast-enhanced US-assisted Percutaneous Nephrostomy: A Technique to Increase Success Rate for Patients with Nondilated Renal Collecting System. Radiology. 2017 Oct; 285(1):293-301. https://doi.org/10.1148/radiol.2017161604 3. Usawachintachit M, Tzou DT, Mongan J et al. Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System. J Endourol. 2017 Feb; 31 (2): 129-134. https://doi.org/10.1089/end.2016.0693 4. Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol. 2011 Dec; 28(4):424-37. https://doi.org/10.1055/S-0031-1296085 5. Brandes S, Coburn M, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: an evidencebased analysis. BJU Int. 2004 Aug; 94(3):277-89. https://doi.org/10.1111 /j.1464-410X.2004.04978.X 6. Ray CE Jr, Brown AC, Smith MT, Rochon PJ. Percutaneous access of nondilated renal collecting systems. Semin Intervent Radiol. 2014 Mar; 31 (1):98-100. https://doi.org/10.1055/S-0033-1363849 7. American College of Radiology (ACR) and the Standarts of Practice Committee of the Society of Interventional Radiology (SIR) and the Society for Pediatric Radiology (SPR) practice guideline for the performance of percutaneous nephrostomy. Revised 2011 (resolution 42). Accessed March 9, 2013. http://www.arc.org/~/media/ACR/Documents/PGTS/guidelines/Percutaneous_Nephrostomv.pdf 8. Clark TW, Abraham RJ, Flemming BK. Is routine micropuncture access necessary for percutaneous nephrostomy? A randomized trial. Can Assoc Radiol J. 2002 Apr; 53(2):87-91.
Abstract Aim: was to assess feasibility and effectiveness of using special methods for preventing of port-biliary fistula formation, at all stages of percutaneous transhepatic cholangiostomy (PTC). Material and methods: we analyzed results of 3786 cholangiostomies with Seldinger technique, performed during the period from 1995 to 2019. Primary puncture of target bile duct was performed with a 17,5-18G needle for Amplaz guidewire 0,035’’ with a safe J-tip. With benign lesion of the biliary tree, 2066 cholangiostomies (54.6%) were performed, with tumor – 1720 (45,4%). Results: significant hemobilia was registered in 21 patients (0.55%) from the analyzed group (3786 PTC), while in 3 cases arteriobiliary fistula was diagnosed, in 16-portbiliary fistula, 2 - biliary-venous fistula. The frequency of portоbiliary fistulas was 0,42%. The presence of blood impurities during aspiration from bile ducts was considered as obvious sign of portоbiliary fistula. Prevention of the formation of port-biliary fistula was realized by using well-guided puncture needles of large diameter (17,5-18G), including use of the «open needle» technique and timely changing the puncture trajectory during puncture of the vessel before penetration of the bile duct. Discredited access was used only for cholangiography with simultaneous puncture of bile ducts with a second needle along a different path and control of the severity of hemobilia according to the established second conflict-free cholangiostoma. All portоbiliary fistulas were closed conservatively. Conclusion: the use of special methods of prophylaxis, determined a low frequency of portоbiliary fistulas - 4.2 port-biliary fistulas per 1000 percutaneous transhepatic cholangiostomy (0,42%), as well as their relatively benign nature (marginal wound of lateral portal vein branches), which did not require the use of embolization techniques. References 1. Shiau EL, Liang HL, Lin YH. (et al.). The Complication of Hepatic Artery Injuries of 1,304 Percutaneous Transhepatic Biliary Drainage in a Single Institute. J Vasc Interv Radiol. 2017 Jul;28(7):1025-1032. doi: 10.1016/j.jvir. 2017.03.016. 2. Dolgushin BI, Virshke ER, Cherkasov VA, Kukushkin VA, Mkrtchjan GS. Selective Embolization of Hepatic Arteries in Bleeding Complications of Percutaneous Transhepatic Biliary Dranage. Annaly khirurgicheskoy gepatologii. Annals of HPB surgery. 2007; 12(4): 63-68 [In Russ]. 3. Aung TH, Too CW, Kumar N (et al.). Severe Bleeding after Percutaneous Transhepatic Drainage of the Biliary System. Radiology. 2016 Mar; 278(3):957-8. doi: 10.1148/ radiol.2016151954. 4. Saad WE, Wallace MJ, Wojak JC (et al.). Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol. 2010 Jun; 21(6): 789-95. doi: 10.1016/j.jvir.2010.01.012. 5. Dietrich CF, Lorentzen T, Appelbaum L (et al.). EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III-abdominal treatment procedures (Long Version). Ultraschall Med. 2016 Feb;37(1):E1-E32. doi: 10.1055/s-0035-1553917. 6. Mortimer AM, Wallis A, Planner A. Multiphase multidetector CT in the diagnosis of haemobilia: a potentially catastrophic ruptured hepatic artery aneurysm complicating the treatment of a patient with locally advanced rectal cancer. Br J Radiol. 2011, May; 84(1001):e95-8. doi: 10.1259/bjr/20779582. 7. Quencer KB, Tadros AS, Marashi KB (et al.). Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments. J Clin Med. 2018 May 1;7(5). pii: E94. Doi 10.3390/jcm7050094. 8. Chanyaputhipong J, Lo RH, Tan BS, Chow PK Portobiliary fistula: successful transcatheter treatment with embolisation coils. Singapore Med J. 2014 Mar; 55(3):e34-6. 9. Madhusudhan KS, Dash NR, Afsan A (et al.). Delayed Severe Hemobilia Due to Bilio-venous Fistula After Percutaneous Transhepatic Biliary Drainage: Treatment With Covered Stent Placement. J Clin Exp Hepatol. 2016 Sep; 6(3):241-243.
Abstract: Article presents a case report of successful antegrade x-ray surgical access to the biliary tree ir order to eliminate partial clipping of the common bile duct as a complication of endoscopic cholecystectomy Percutaneous transhepatic puncture of the unexpanded biliary tree was made under ultrasounc control without auxiliary contrast enhancement of the bile tree. After punction - antegrade cholangiography revealed partial clipping of common bile duct. Patient underwent balloon dilatation, internal-external transpapillaty drainage. Three-times balloon dilatation after each 2 months made it possible to avoid the formation of posttraumatic stricture and the long-frame external-internal drainage of the biliary tree. The use of antegrade percutaneous transhepatic access to restore adequate passage of bile to the duodenum, including cases without dissection of the papilla, is advisable in clinical situations that do not allow the use of retrograde endoscopic access, or if it is ineffective. References 1. Kuznecov N.A., Sokolov A.A., Brontvein A.T., Artemkin EH.N. Diagnostics and treatment of early biliary complications after a cholecystectomy. Khirurgiya. 2011; 3: 3-7 [In Russ]. 2. Eisenstein S, Greenstein AJ, Kim U, Divino CM. Cystic duct stump leaks: after the learning curve. Arch Surg. 2008; 143( 12): 1178-83. doi: 10.1001/archsurg. 143.12.1178. 3. Shaikh IA, Thomas H, Joga K (et al.). Post-cholecystectomy cystic duct stump leak: a preventable morbidity. J Dig Dis. 2009 Aug; 10(3):207-12. doi: 10.1111/j. 1751 - 2980.2009.00387.x. 4. Barband AR, Kakaei F, Daryani A, 5. Shawhan RR, Porta CR, Bingham JR (et al.). Biliary leak rates after cholecystectomy and intraoperative cholangiogram in surgical residency. Mil Med. 2015 May; 180(5):565-9. doi: 10.7205/MILMED-D-14-00426. 6. Lo Nigro C, Geraci G, Sciuto A, (et al.).Bile leaks after videolaparoscopic cholecystectomy: duct of Luschka. Endoscopic treatment in a single centre and brief literature review on current management. Ann Ital Chir. 2012 Jul-Aug; 83(4):303-12. 7. Doumenc B, Boutros M, Dйgremont R, Bouras AF. Biliary leakage from gallbladder bed after cholecystectomy: Luschka duct or hepaticocholecystic duct? Morpholo- gie. 2016 Mar; 100(328):36-40. doi: 10.1016/j.morpho.2015.08.003. 8. Pancyrev YU.M., SHapoval'yanc S.G., CHernyakevich 9. Ohotnikov O.I., YAkovleva M.V., Grigor'ev S.N. X-ray surgery of «small» damages of bilious channels during cholecystectomy. Annaly hirurgicheskoj gepatologii.2017; 1(22):64-70 [In Russ]. 10. Sinha R, Chandra S. Cystic duct leaks after laparoendoscopic single-site cholecystectomy. J Laparoendosc Adv Surg Tech A. 2012 Jul-Aug; 22(6):533-7. doi: 10.1089/lap.2012.0094. 11. Kim KH, Kim TN. Endoscopic management of bile leakage after cholecystectomy: a single-center experience for 12 years. Clin Endosc. 2014 May; 47(3):248-53. doi: 10.5946/ce.2014.47.3.248. 12. Beburishvili A.G., Zubina E.N., Akinchits A.N., Vedenin YI. External biliary leakage after different types of cholecystectomy: diagnostics and treatment. Annaly khirurgicheskoy gepatologii. 2009; 14 (3): 18-21 [In Russ]. 13. Gwon D, Ko GY Sung KB, Kim JH, Yoon HK. Percutaneous transhepatic treatment of postoperative bile leaks: prospective evaluation of retrievable covered stent. J Vasc Interv Radiol. 2011 Jan;22(1 ):75-83. doi: 10.1016/ j.jvir. 2010.10.004. 14. de Jong EA, Moelker A, Leertouwer T, Spronk S, Van Dijk M, van Eijck CH. Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated intrahepatic bile ducts. Dig Surg. 2013;30(4- 6):444-50. doi: 10.1159/000356711.
Abstract: Aim: was to determine indications for transpapillary external-internal drainage of the biliary tree in benign diseases of the peripapillary region. Material and methods: results of the use of externally-internally transpapillary drainage of the biliary tree from 256 patients with distal obstruction of the biliary tract were analyzed. In 154 (60,2%) cases the peripapillary obstruction was caused by tumor pathology, in 102(39,8%) cases (39.8 %) - by peripapillary benign stenotic diseases (stenosis of Vater papilla, choledocholithiasis, chronic pancreatitis, parapapillary diverticula) that have not managed to eliminate with the help of endoscopy or endoscopic benefit was initially ineffective. Results: endoscopic papillosphincterotomy after the external-internal drainage due to syndrome of Vater papilla «acute blockage» required in 7(4,5%) patients of 154 patients with peripapillary tumor obstruction. Endoscopic papillotomy was performed in 80(78,4%) patients among 102 patients with benign distal block of common biliary duct after the external-internal drainage for same indications. In 7 cases of «acute blockage» of papilla we were forced to return to the outside cholangiostomy due to endoscopic unattainable of papilla. In summary, the syndrome of papilla «acute blockage» occurred in 87(85,3%) patients with transpapillary external- internal drainage of the biliary tree on the background of the peripapillary benign obstruction. There were no complications of papillotomy Conclusion: the external-internal drainage of the biliary tree with the syndrome of obstructive jaundice remains an effective and pragmatic method of return of bile into the lumen of the duodenum. The most common complication of the external-internal drainage with transpapillary drainage placement is a syndrome of «acute blockage» of Vater papilla which requires endoscopic papillotomy With high frequency this syndrome occurs when forced transpapillary the external-internal drainage of the distal benign disorders of patency of the biliary tree. Minimal risk of this syndrome developing has been reported during transpapillary drainage in patients with obstructive jaundice due to peripapillary cancer. References 1. Jendobiliarnaja intervencionnaja onkoradiologija pod red. Dolgushina B.I. [Endobiliary interventional oncoradiology under edition of Dolgushin B.I.]. Moscow. 2004: 224 [In Russ]. 2. Intervencionnaja radiologija v onkologii (puti razvitija i tehnologii): Nauchno-prakticheskoe izdanie. Gl. red.: Granov A.M. i Davydov M.I.; red.: Tarazov P.G. i Granov D.A. 2- e izd., dop [Interventional radiology in oncology (the path of development and technology): Scientific-practical publication. hl. еd.: Granov A.M. and Davydov MI; еd .: Tarazov P.G. and Granov D.A. 2nd ed, dop.]. St. Petersburg. 2013: 560 [In Russ]. 3. Qian X.J., Zhai R.Y, Dai D.K, et al. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment. World J Gastroenterol. 2006; 12(2):331-5. 4. Luchevaja diagnostika i maloinvazivnoe lechenie mehanicheskoj zheltuhi. Rukovodstvo pod red. Kokova L.S., Chernoj N.R., Kuleznevoj Ju.V. [Radiological diagnosis and minimally invasive treatment of obstructive jaundice. Guide. Under edition of Kokov L.S., Chernaya N.R., Kulezneva Ju.V.]. Moscow. 2010: 288 [In Russ]. 5. Jo J.H., Park B.H. Suprapapillary versus transpapillary stent placement for malignant biliary obstruction: which is better? J Vasc Interv Radiol. 2015; 26(4):573-582. 6. Lee D.H., Yu J.S., Hwang J.C., Kim K.H. Percutaneous placement of self-expandable metallic biliary stents in malignant extrahepatic strictures: indications of transpapillary and suprapapillary methods. Korean J Radiol. 2000;1(2):65-72.
Abstract: Aim: was to estimate the expediency of one-time sanation of the gallbladder, performed under ultrasound control in patients with acute cholecystitis as a preoperative preparation. Material and methods. For the period 2007-2016, 1365 sanations of the gallbladder were performed in 1289 patients with acute cholecystitis. In 1284 cases (94.1%), the manipulation was single-staged, performed under local anesthesia by echo-puncture needles, caliber of 17.5 G under ultrasound control by the "free hand" method or using a program of biopsy cursor, percutaneously transhepatic. Access was made through the hepatic parenchyma with a thickness of at least 10 mm. Results. Sanation of the gallbladder was effective in all 1365 cases. Repeated sanitation in a day was necessary in 76 patients. Cholecystectomy within the current hospitalization was performed ir 1132 of (87.8%) 1289 patients, in terms from 1 to 4 days after initial manipulation. The dislocation of the blocking gall-stone from the cervical region of the gallbladder into its lumen was made with a rigid 0.035" gidewire in order to restore cystic duct flow was effective in 122 cases (35.2%). Complications: subcapsular hematomas of the liver in the puncture zone - 4 (0.3%), bilomus of the gallbladder bed - 1 (0.07%), bleeding to the gallbladder lumen - 11 (0.8%) were treated conservatively. There were no lethal outcomes. Conclusion: one-time sanation of gallbladder allows to decompress safely the gallbladder, to stop pain syndrome, to conduct a full pre-examination and preoperative preparation of patient and perform cholecystectomy in the most comfortable and safe conditions in a delayed or planned order. References 1. Buyanov V.M., Ishutinov V.D., Zinyakova M.V., Titkova I.M. Ultrazvukovaya klassifikatsia ostrogo holetsistita. [Ultrasound classification of acute cholecystitis.] Vserossijskaja konferencija hirurgov: Tezisy dokladov. [Proc. Conf. Surgeons: All-Russian conference of surgeons: Tez. dokl]. Yessentuki. 1994; 51-52 [In Russ]. 2. Takada T., Strasberg S.M., Solomkin J.S., Pitt H.A., Gomi H., Yoshida M., Mayumi T., Miura F., Gouma D.J., Garden O.J., Bьchler M.W., Kiriyama S., Yokoe M., Kimura Y, Tsuyuguchi T., Itoi T., Gabata T., Higuchi R., Okamoto K., Hata J., Murata A., Kusachi S., Windsor J.A., Supe A.N., Lee S., Chen X.P., Yamashita Y, Hirata K., Inui K., Sumiyama Y Tokyo Guidelines Revision Committee. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013; 20(1): 1 -7. doi: 10.1007/s00534-012-0566-y. PMID: 23307006. 3. Yokoe M., Takada T., Strasberg S.M., Solomkin J.S., Mayumi T., Gomi H., Pitt H.A., Garden O.J., Kiriyama S., Hata J., Gabata T., Yoshida M., Miura F., Okamoto K., Tsuyuguchi T., Itoi T., Yamashita Y, Dervenis C., Chan A.C., Lau W.Y, Supe A.N., Belli G., Hilvano S.C., Liau K.H., Kim M.H., Kim S.W., Ker C.G. Tokyo Guidelines Revision Committee. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013; 20(1):35-46. doi: 10.1007/s00534-012-0568-9. PMID: 23340953. 4. Kimura Y, Takada T., Strasberg S.M., Pitt H.A., Gouma D.J., Garden O.J., Bьchler M.W., Windsor J.A., Mayumi T., Yoshida M., Miura F., Higuchi R., Gabata T., Hata J., Gomi H., Dervenis C., Lau W.Y, Belli G., Kim M.H., Hilvano S.C., Yamashita Y TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013; 20( 1 ):8-23. doi: 10.1007/s00534-012-0564-0. PMID: 23307004. 5. Mayumi T., Someya K., Ootubo H., Takama T., Kido T., Kamezaki F., Yoshida M., Takada T. Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis. J UOEH. 2013; 35(4):249-57. PMID: 24334691. 6. Briskin B.S., Minasyan A.M., Vasilieva М.А., Barsukov M.G. Chreskozhnaja chrespechenochnaja mikroholecistostomija v lechenii ostrogo holecistita. [Percutaneous transhepatic microcholecystostomy in acute cholecystitis treatment]. Annaly khirurgicheskoy gepatologii. 1996; 1(1):98-107 [In Russ]. 7. Ivanov S. V., Okhotnikov O.
Abstract: Aim: was to improve the efficiency of external drainage in patients with biliary tree obstruction by tumor process in the porta hepatis zone. Materials and methods: percutaneous transhepatic cholangiostomy under the combined sonofluoroscopic control with using on the first phase of the treatment of self-locking drainages pig tail №8Fr followed by external-internal drainage or endobiliary stenting were performed in 147 patients with «high» tumor block of the biliary tree. Results: depending on the extent of biliary occlusion there were from 1 to 6 drainages. «Big» post-manipulating complication encountered in one patient (0.7%) - migration of cholangiostomic drainage with the development of biliary peritonitis. «Small» complications (short-period haemobilia, migration of cholangiostomy amilazemiya at transpapillary insertion of an external-internal drainage) occurred in 20 patients (13.6%). Mortality rate was 6.1%. Death causes: common bile peritonitis (1 case), and the progression of hepatorenal insufficiency on the background of biliary decompression (8 cases). Conclusion: antegrade cholangiostomy at «high» tumor obstruction of the biliary tree is a necessary manipulation as in palliative biliary decompression, and in the preparation of the patient for radical surgery for Klatskin tumors. Satisfactory performance of postmanipulating complications and in-hospital mortality involve the use of special techniques for effective external and external-internal drainage of bile ducts. References 1. Witzigmann H., Lang H., Lauer H. Guidelines for palliative surgery of cholangiocarcinoma HPB (Oxford). Jun 1, 2008; 10(3): 154-160. doi: 10.1080/13651820801992567 PMCID: PMC2504365. 2. Rerknimitr R., Kullavanijaya P. Operable malignant jaundice: To stent or not to stent before the operation? World J. Gastrointest. Endosc. 2010 Jan 16;2(1):10-4. doi: 10.4253/wjge.v2.i1.10. 3. Paik W.H., Loganathan N., Hwang J.H. Preoperative biliary drainage in hilar cholangiocarcinoma: When and how? World J. Gastrointest. Endosc. 2014 Mar 16;6(3):68-73. doi: 10.4253/wjge.v6.i3.68. Review. 4. Liu F., Li Y, Wei Y, Li B. Preoperative biliary drainage before resection for hilar cholangiocarcinoma: whether or not? A systematic review. Dig. Dis. Sci. 2011 Mar; 56(3):663-72. doi: 10.1007/s10620-010-1338-7. Epub 2010 Jul 16. 5. Kawakami H., Kondo S., Kuwatani M., Yamato H., Ehira N., Kudo T., Eto K., Haba S., Matsumoto J., Kato K., Tsuchikawa T., Tanaka E., Hirano S., Asaka M. Preoperative biliary drainage for hilar cholangiocarcinoma: which stent should be selected? J. Hepatobiliary Pancreat Sci. 2011 Sep; 18 (5):630-5. doi: 10.1007/s00534-011- 0404-7. 6. Ustunda Y, Boyvat F. Debate continues over which method we should prefer for the preoperative biliary decompression in cases with hilar cholangiocarcinoma. J. Gastroenterol. 2012 Jan; 47(1):88-9; author reply 90-1. doi: 10.1007/s00535-011-0496-5. Epub 2011 Nov 15. 7. Nuzzo G., Giuliante F., Ardito F., Giovannini I., Aldrighetti L., Belli G., Bresadola F., Calise F., Dalla Valle R., D’Amico D. F., Gennari L., Giulini S. M., Guglielmi A., Jovine E., Pellicci R., Pernthaler H., Pinna A.D., Puleo S., Torzilli G., Capussotti L., Improvement in perioperative and longterm outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian
Experience of 100 successful antegrade transhepatic contact choledocholithothripsy as treatment in patients with difficulties of endoscopy method
DOI: https://doi.org/10.25512/DIR.2011.05.1.08
For quoting:
Okhotnikov O.I., Grigoriev S.N., Yakovleva M.V. "Experience of 100 successful antegrade transhepatic contact choledocholithothripsy as treatment in patients with difficulties of endoscopy method". Journal Diagnostic & interventional radiology. 2011; 5(1); 67-72.
Abstract: We have retrospectively analyzed results of 100 patients’ interventional radiology methods in cases of difficulties during endoscopy choledocholithiasis treatment. It was determined that transcutaneous transhepatic cholangiostomy is a universal method of biliary decompression in case of dilatation of intrahepatic bile ducts, and can be the first stage of treatment in patients with choledocholithiasis which may be transformed consistently in endoscopic interventions, or – in case of its inefficiency or inexpediency may be transformed into percutaneous choledocholithotripsy and lithoextraction. The number of choledocholithotripsy and lithoextraction varied from 1 to 3 interference. Adequacy of lithoextraction from common bile duct was controlled by the repeated direct cholangioscopy and was confirmed by antegrade cholangiography. Complications of transhepatic method of choledocholithotripsy and lithoextraction included bacterial shock (6%), insignificant hemobilia (8%), migration (4%) and dislocation of cholangiostomy with disturbance of its drainage function (7%). Complications were eliminated successfully and didn’t change treatment tactic. There were no fatal outcomes in investigated group of patients. Antegrade percutaneous choledocholithotripsy and lithoextraction is the method of choice in case of impossibility of transpapillary endoscopical or traditional surgical treatment of choledoholithiasis. References 1. Нестеренко Ю.А., Лаптев В.В., Цкаев А.Ю. и др. Актуальные вопросы диагностики и лечения больных микрохоледохолитиазом. Анналы хирургической гепатологии. 2007; 12 (2): 62–68. 2. Котовский А.Е., Глебов К.Г. Эндоскопическое транспапиллярное стентирование желчных протоков. Анналы хирургической гепатологии. 2008; 13 (1): 66–71. 3. Шевченко Ю.Л., Ветшев П.С., Стойко Ю.М. и др. Диагностика и хирургическая тактика при синдроме механической желтухи. Анналы хирургической гепатологии. 2008; 13 (4): 96–105. 4. Балалыкин А.С., Балалыкин В.Д., Гвоздик В.В. и др. Дискуссионные вопросы хирургических вмешательств на большом сосочке двенадцатиперстной кишки. Анналы хирургической гепатологии. 2007; 12 (4):45–50. 5. Гальперин Э.И., Ветшев П.С. Руководство по хирургии желчных путей. М.: Издательский дом Видар-М. 2006; 568. 6. Шулутко А.М. Хирургическое лечение желчнокаменной болезни. 50 лекций по хирургии. М.: Медиа Медика. 2003; 198–206. 7. Истомин Н.П., Султанов С.А., Архипов А.А. Двухэтапная тактика лечения желчнокаменной болезни, осложненной холедохолитиазом. Хирургия. 2005; 1: 48–50. 8. Chen C. et al. Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis. Surg. Endosc. 2005; 19 (4): 505–509. 9. Ell C. et al. Laser lithotripsy of difficult bile duct stones by means of a rhodamine-6G laser and integrated automatic stone-tissue detection system. Gastrointest Endosc. 1993; 39: 755–762. 10. Nadler R.B. et al. Percutaneous hepatolithotomy. Тhe the Northwestern University experience. Endourol. 2002; 16: 293–297.
11. Ogawa K. et al. Percutaneous trashepatic small-caliber choledochoscopic lithotomy. А safe and effective technique for percutaneous transhepatic common bile duct exploration in high-risk eldery patients. Hepatobiliary Pancreat Surg. 2002; 9 (2): 213–217. 12. Долгушин Б.И., Патютко Ю.И., Нечипай А.М. и др. Антеградные эндобилиарные вмешательства в онкологии. Причины, профилактика и лечение осложнений. М.: Практическая медицина. 2005; 176.
Abstract: We have retrospectively analyzed results of 12 patients underwent radiological interventions for scarring strictures correction of biliodigestive anastomoses after reconstructive surgery due to iatrogenic damage of extra hepatic biliary ducts. It was determined that ultrasonography is the main technique of biliary hypertension diagnostics. Antegrade cholangiography gives an ability to determine the level and type of extrahepatic biliary ducts strictures. Adequate biliary decompression was achieved by transcutaneous transhepatic drainage of biliary tree with insertion of cholangiostomical drainage near the biliodigestive anastomoses. Antegrade recanalization technique and dilatation of biliodigestive anastomosis strictures was used for dilatation of scarring stricture. Balloon plastic of anastomoses was ended with forming of external-internal draining for 9-12 months with step-by-step balloon dilatations every 3 months. Stenting of biliodigestive anastomosis' strictures was made in 4 cases Postoperative period without relapses after radiological interventions lasts from 2 till 7 years of observing. References 1. Хотиняну В.Ф., Фердохлеб А.Г., Хотиняну А.В. Хирургическое лечение больных со стриктурами внепеченочных желчных протоков. Анналы хирургической гепатологии. 2008; 13 (1): 61-65. 2. Гальперин Э.И. Что должен делать хирург при повреждении желчных протоков? 50 лекций по хирургии. М.: Медиа Медика. 2003; 198-206. 3. 3. Гальперин Э.И., Чевокин А.Ю. Факторы, определяющие выбор операции при «свежих» повреждениях магистральных желчных протоков. Анналы хирургической гепатологии. 2009; 14 (1): 49-56. 4. Руководство по хирургии желчных путей. Под ред. Э.И. Гальперина, П.С. Ветшева. М.: Издательский дом Видар-М. 2006; 568. 5. Murr M.M. et al. Of biliary reconstruction after laparoscopic bile duct injuries. Arch. Surg. 1999; 134 (6): 604-610. 6. Schmidt S.C. et al. Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. Br. J.Surg. 2005; 92 (1): 76-82. 7. McPherson S.J. et al. Percutaneous transjejunal biliary intervention. 10-year experience with access via Roux-en-Y loops. Radiology. 1998; 206: 665-672. 8. Quintero G.A., Patino J.F. Surgical management of benign strictures of biliary tract. 9. World. J. Surg. 2001; 25: 1245-1250. Корымасов Е.А., Богданов В.Е., Романов В.Е. и др. Эффективность эндобилиарных вмешательств при стриктурах протоков и анастомозов. Анналы хирургической гепатологии. 2008; 13 (3): 123-124. 10. Хальзов А.В., Анищенко В.В., Штофин С.Г. Применение нитиноловых стентов для лечения посттравматических рубцовых стриктур внепеченочных желчных протоков. Анналы хирургической гепатологии. 2008; 13 (3): 144. 11. Bismuth N., Majno P.E. Вiliary strictures. Classification based on the principle of surgical treatment. World. J. Surg. 2001; 25 (10): 1241-1244.
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Abstract: Article describes the experience of X-ray-surgical treatment of patient with clinical and laboratory manifestations of cholestasis without a concomitant expansion of bile ducts. In anamnesis of disease - left-sided hemihepatectomy, hepaticojejunostomy on wireframe transhepatic drainage for treatment of portal cholangiocarcinoma III-b, 6 courses of adjuvant chemotherapy. Frame-drainage was removed after 6.5 months after surgery and 2 weeks before this hospitalization. Bilirubinemia (bilirubin 394.89 (233,00-161,89) mol/L) with signs dysproteinemia, cytolysis and anticoagulation were marked during the hospitalization. Lack of pneumobilia during sonography suggested that the most likely cause of cholestasis is a violation of the biliodigestive anastomosis patency Antegrade biliary decompression led to the development of hepatic failure, which was successfully treated by syndromic intensive therapy Following antegrade balloon dilatation of biliodigestive anastomosis area with its external-internal frame-drainage let us to eliminate clinical and laboratory manifestations of obstructive jaundice. Conclusion: the need for a surgical biliary decompression in cancer patients with cholestasis without a significant expansion of bile ducts with a decrease of functional reserves of the liver is accompanied by the risk of development or progression of liver failure, which leads to complexity and ambiguity of the choice of treatment strategy in these patients. References 1. Yurchenko V.V. Javljaetsja li suprastenoticheskaja dilatacija objazatel'nym simptomom narushenija ottoka zhelchi? [Is suprastenotic dilatation a mandatory symptom of impaired bile outflow?] Vestnik rentgenologii i radiologii. 2015; 3: 18-22. [In Russ].
