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.