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XXVIII Пленум Правления Белорусской ассоциации хирургов
«Актуальные вопросы и современные подходы в оказании
хирургической помощи в Республике Беларусь»
18-19 ноября 2021 года в г. Минск.
Year 2018 Vol. 26 No 1
EXCHANGE OF EXPERIENCE
K.M. KURBONOV, U.U. MANSUROV, K.R. NAZIRBOEV
SURGICAL TREATMENT TACTICS OF IATROGENIC LESIONS AND CICATRICIAL STRICTURES OF EXRTAHEPATIC BILE DUCTS
Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan
Objective. To improve the results of surgical treatment of iatrogenic lesions and cicatricial strictures of extrahepatic bile ducts using timely two-stage treatment tactics.
Methods. The results of surgical treatment of 48 patients with iatrogenic lesions of extrahepatic bile ducts (EBD) in the period from 2004 to 2016 years were analyzed. New damages were observed in 17 (35.4%), scar strictures – in 31 (64.6%).
Results. In most cases the causes of lesions were: laparoscopic cholecystectomy – 39 (81.2%), traditional cholecystectomy – 3 (6.2%) and cholecystectomy from mini-access – 2 (4.2%). Overall, cholecystectomy accounted for 44 (91.6%) of the total number of interventions. In other cases, the causes of iatrogenic injuries of EBD were echinococcectomy from the liver in 2 cases, resection of the stomach – in 1 and pancreatic necroectomy in one patient. Iatrogenic injuries of EBD occurred in the clinic in 17 (35.4%), but the remaining patients were accordingly transferred from other institutions of the republic. When choosing a treatment strategy and the nature of surgical interventions one considered the time of diagnosis, severity of the patient’s state, the kind and nature of the iatrogenic lesion or strictures of EBD, as well as secondary complications. In 5 (10.4%) of 17 patients with new EBD injuries, the lesions were diagnosed intraoperatively. In 31 (64.6%) patients, postoperative cicatricial strictures were revealed. These patients were adhered to strictly two-stage therapeutic tactics. Various reconstructive surgeries were performed, including choledochojunoanastomosis on Roux - 9 patients and bihepaticojunoanastomosis on Roux - 15 cases. Of all 48 operated patients, postoperative complications were observed in 6 (12.5%) patients. Postoperative mortality made up 3 patients.
Conclusions. The main type of reconstructive treatment of iatrogenic lesions and cicatricial strictures of EBD are bi-, tri- and Roux hepaticojunoanastomosis on jejunum loop, depending on the localization level of injury or stricture.
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734003, The Republic of Tajikistan,
Dushanbe, Rudaki Ave., 139,
Avicenna Tajik State Medical University,
Department of Surgical Diseases № 1,
Tel. office: +992 98 555-78-88,
Mansurov Usmon U.
Kurbonov Karimhon M., MD, Professor, Academician of Academy of Medical Sciences of the Republic of Tajikistan, Honored Worker of Science and Technology of the Republic of Tajikistan, Head of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
Mansurov Usmon U., Post-Graduate Student of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
Nazirboev Kahramon R., PhD, Assistant of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.