RESUMO
For the period of 6 years we have 110 patients with recurrent bile duct stones (BDS). Were evaluated the changes of the bile duct and bile papilla (BP), predisposing to the recurrence of BDS; the causes of recurrent BDS after endoscopic papillosphincterotomy (EPST). To improve the treatment results in patients with recurrent BDS is necessary: at the primary operation to estimate the changes of the BP and periampulyarnuyu area, in patients with completed EPST to prescribe litolitic therapy; in patients with a complex BDS after unsuccessful attempt of EPST to do holedoholitotomy with a blind stitch or in combination with the drainage of Pikovsky.
Assuntos
Colecistectomia/métodos , Coledocolitíase , Esfinterotomia Endoscópica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico , Coledocolitíase/prevenção & controle , Coledocolitíase/cirurgia , Ducto Colédoco/cirurgia , Drenagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Prevenção Secundária , Fatores de Tempo , Resultado do TratamentoRESUMO
The treatment results of 69 patients with the altered bilioduodenal anatomy and choledocholithiasis, complicated by the obstructive jaundice, were analyzed. The anatomic changes were determined by the previous gastric resection or gastrectomy, biliodigestive anastomosis, bile duct strictures, pyloric stenosis, duodenal diverticulum or the Mirizzi syndrome. The surgical approach depended on the type and extent of anatomic changes. The endoscopic common bile duct decompression was possible in 82,6% of patients. The endoscopic bile duct stone removal was achieved only in 44,9% of patients, the other 8,7% with non-removable stones had the endoscopic bile duct stenting as a means of palliative surgery. Percutaneous transhepatic lithoextraction was performed in 1,5% of cases. The differential approach provided the decrease of postoperative complication rate and lethality to 14,5 and 2,9%, respectively.