[Non-functioning gallbladder as a risk factor for bile ducts injury during laparoscopic cholecystectomy]. / Nefunktsioniruiushchii zhelchnyi puzyr' kak faktor riska travm zhelchnykh protokov pri laparoskopicheskoi kholetsistéktomii.

AIM: To analyze the effect of gallbladder's morpho-functional changes as a risk factor for injury of extrahepatic bile ducts during cholecystectomy. MATERIAL AND METHODS: Laparoscopic cholecystectomy was performed in 20 564 patients. There were 147 64 (71.8%) patients with chronic gallbladder inflammation and 5800 (28.2%) - with acute process. It was performed a retrospective analysis of the incidence and causes of intraoperative trauma of extrahepatic bile ducts and bile outflow. Two groups of comparison were distinguished: acute calculous cholecystitis and chronic inflammation. RESULTS: There were 93 (0.04%) complications followed by bile outflow (55 (0.94%) in the 1st group and 38 (0.25%) in the 2nd group). Marginal injury of the ducts was interoperatively detected in 5 patients of group 1 and 3 patients of 2 groups. In postoperative period it was found in 6 patients of the 1st group due to electric trauma of common bile duct. Complete transection of common bile duct occurred in 10 (8.8%) cases, while chronic calculous cholecystitis was observed in 8 of them. At the same time, in 6 patients these were surgical interventions in scleroatrophic gallbladder. As a results, we determined the forms of non-functioning gallbladder with morphofunctional changes which promote trauma of extrahepatic bile ducts. CONCLUSION: Long-term non-functioning gallbladder leads to cicatricial and adhesive processes in its wall and surrounding tissues that significantly complicates cholecystectomy and increases the risk of bile ducts trauma. Scleroatrophic gallbladder is the most dangerous which occurs in 4.1% of patients with chronic calculous cholecystitis. Further trials are advisable to develop optimal therapeutic and diagnostic tactics for various forms of long-term non-functioning gallbladder.

[Diagnostics and surgical tactics for Mirizzi syndrome].

Analysis of clinical investigation and surgical treatment of 284 patients with Mirizzi syndrome (MS) was carried out. According to A.Csendes and co-authors classification (1989) 223 patients had the I type of MS, 49 patients--the II type, 9 patients--the III type, 3 patients--the IV type. Diagnosis was ascertained before the operation in 27.4% of patients; with the help of ultrasound study--in 9.1%, by means of retrograde cholangiopancreatography--in 18.3%. In other cases diagnosis was determined during the operation. Mode of the operation depended on the type of MS. Perioperative duct damage was signed in 4 cases (1.4%). Laparoscopic cholecystectomy (LCE) was carried out to 56 patients; cholecystectomy from mini-access--to 41 patients. Remaining 187 patients underwent abdominal operation. In 2 cases operation was finished by external duct drainage; in 7 Roo choledochojejunostoma was formed. Authors suggest that the I type of MS is not a contra-indication for LCE. In case of difficulties in LCE switch to cholecystectomy from mini-access is preferable.

[Ultrasound diagnosis of acute cholecystitis]. / Ul'trazvukovaia diagnostika ostrogo kholetsistita.

The results of ultrasonographic examination of the gall-bladder in its acute inflammation in 1070 patients are presented. Parallels between the anatomic changes and ultrasound visual picture of the inflamed wall of the gall-bladder were drawn. The analysis of the results of the examination revealed the most typical symptoms of acute cholecystitis and permitted to differentiate it from similar ultrasonographic symptoms in other diseases of the gall-bladder. From all patients who underwent surgical treatment or diagnostic laparoscopy, the diagnosis was confirmed in 97%. The possibilities of the method in a series of patients after the operation and patients with concomitant diseases are limited, in such cases the punction or drainage of the gall-bladder under the ultrasound scan control for diagnostics and treatment is advisable.