MODERN APPROACH TO THE TREATMENT OF CHOLELITHIASIS COMPLICATED BY OBSTRUCTIVE JAUNDICE
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 10, Pages 413-418
AbstractResearch objective: to analyze the treatment outcomes after using various methods of biliary tract decompression in patients with cholelithiasis complicated by obstructive jaundice.
Material and methods. 446 patients with cholelithiasis complicated by obstructive jaundice underwent treatment in the Surgical Department of the 1st City Clinical Hospital in Tashkent in the period from 2006 to 2019. 388 (87.1%) patients underwent multistage endoscopic retrograde transpapillary interventions. Duodenoscopy, retrograde cholangio-pancreatography followed by endoscopic papillosphincterotomy (EPST), in combination with choledocholithoextraction (CLE), were performed in 362 patients (93.3%). Besides, we carried out laboratory studies on blood parameters: total bilirubin, ALT, AST, ALP and gamma GGT, characterizing cholestasis and the degree of damage to the liver cells, as well as assessment of specific complications and mortality.
Results. The analysis of treatment outcomes established the following: 22 (4.9%) critically ill patients were applied cholecystostomy under ultrasound control, which allowed to obtain relief of the inflammation process and biliary tract decompression. Besides, critically ill patients with hyperbilirubinemia and biliary intoxication underwent antegrade drainage of the bile duct by PTBD. In 6.5% of cases, due to large choledocholithiasis and incomplete lithoextraction, we used open cholecystectomy in combination with choledocholithotomy with drainage of CBD. Also it should be mentioned, that the conducted study revealed a significant decrease in bilirubin values in all surveyed groups, as well as significant decrease in ALT and AST values.
Conclusion. The most optimal treatment of cholelithiasis complicated by obstructive jaundice is the two-stage approach using minimally invasive methods. The operation of choice is endoscopic retrograde intervention followed by laparoscopic cholecystectomy. In cases of high hyperbilirubinemia (over 200 μmol/L), CBD enlarged diameters and critically ill patients, the method of choice for the treatment of CBD decompression is PTBD.
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