RESUMEN
The authors discuss the immediate and late results of operations conducted with the [symbol: see text] suturing instrument of their design. It made possible one-stage transduodenal papillosphincteroplasty by application of two rows of tantalum staple sutures with division of the tissue between them--papillosphincterotomy. The authors conducted the operation on 242 patients for benign stenosis of the common bile duct by stones incarcerated in it. In 29 patients the intervention was complemented by the formation of supraduodenal choledochoduodenoanastomosis by means of the same suturing instrument, establishing in this was double internal drainage of the bile ducts. The suturing instrument made the operation easier and atraumatic and provided reliable hemostasis. Immediate postoperative mortality as 1.9%. Transduodenal papillosphincterotomy with the [symbol: see text] suturing instrument produced g od and satisfactory results in 95.2% and poor results in 4.8% of patients; poor late results of double drainage of the choledochus by the authors' method were not registered.
Asunto(s)
Conducto Colédoco/cirugía , Duodeno/cirugía , Cálculos Biliares/cirugía , Esfinterotomía Transduodenal/instrumentación , Técnicas de Sutura/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Constricción Patológica/etiología , Constricción Patológica/cirugía , Drenaje/métodos , Femenino , Cálculos Biliares/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Esfinterotomía Transduodenal/métodos , Grapado Quirúrgico , Factores de TiempoRESUMEN
The data of diagnosis and treatment of 59 patients with stenosis of the major duodenal papilla (MDP) revealed at different periods after cholecystectomy are analysed. In diagnosis of MDP stenosis, the following methods were employed: ultrasounds scanning of the liver and bile ducts, intravenous cholangiography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography. The surgical method of treatment was used in 24, an endoscopic method--in 28, a combined one--in 7 patients. The indications and contraindications for the use of different methods of treatment are presented. It is noted that the use of a complex of modern methods of diagnosis and treatment will permit to establish precisely MDP stenosis after previously performed cholecystectomy and eliminate it with minimal lethality.
Asunto(s)
Ampolla Hepatopancreática , Colecistectomía/efectos adversos , Colecistitis/cirugía , Colestasis Extrahepática/etiología , Enfermedades del Conducto Colédoco/etiología , Anciano , Colestasis Extrahepática/diagnóstico , Colestasis Extrahepática/cirugía , Enfermedades del Conducto Colédoco/diagnóstico , Enfermedades del Conducto Colédoco/cirugía , Constricción Patológica/diagnóstico , Constricción Patológica/etiología , Constricción Patológica/cirugía , Femenino , Humanos , Masculino , Métodos , Persona de Mediana EdadRESUMEN
The results of treatment of 72 patients with ampullary choledocholithiasis (16% of the total number of patients with choledocholithiasis) are presented. In 15 patients, bringing down a concrement was performed, in 3--its retrograde removal via the incision of the common bile duct with subsequent creation of choledochoduodenoanastomosis (CDA), in 24--endoscopic papillosphincterotomy (with subsequent cholecystectomy--in 6, with cholecystectomy and CDA creation--in 18), in 30--cholecystectomy with transduodenal papillosphincteroplasty. After the operation, 5 patients died.