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Year 2013 Vol. 21 No 6
EXCHANGE OF EXPERIENCE
F.I. MAKHMADOV, K.M. KURBANOV, Z.H. NUROV, A.D. GULAHMADOV, A.J. SOBIROV
THE CURRENT ASPECTS OF DIAGNOSTICS AND TREATMENT OF MECHANICAL JAUNDICE
Avicenna Tajik State Medical University, Dushanbe
The Republic of Tajikistan
Objectives. Improvement of immediate treatment results of patients with mechanical jaundice of various etiologies by means of complex usage of minimally invasive diagnostic and treatment methods.
Methods. The given research is based on the results analysis of diagnostics and gradual decompressions of the biliary ducts using minimally invasive technologies in 226 patients with mechanical jaundice (MJ) of different genesis within the period of 2004-2012 yrs. Patients’ age varied from 19 to 89 yrs. Females composed 117 (51,8%), males – 109 (48,2%). Only 192 (84,6%) patients were at once to the surgical in-patient department, the rest 34 (15,4%) were transported from the therapeutic and infectious units. For differentiated diagnostics of MJ non-invasive methods were applied: sonography, fibrogastroduodenoscopy (FGDS), magnetic resonance cholangiopancreatography (MRCP), multislice computer tomography (MSCT) as well as invasive ones: endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTHC).
Results. The research results analysis showed that criteria of informativeness determination of the applied methods were detectability of concretions, strictures of the biliary ducts, mass lesions, dilation of the intrahepatic bile ducts, common hepatic and bile ducts. Different types of endoscopic decompression (n=57) and percutaneous transhepatic cholangiography (n=31) carried out in combination with ERCP and PTHC were considered to be an effective methods of the biliary hypertension elimination. Possibility to perform these types of biliary ducts decompression was subjected to the comparative estimation. The efficacy in the treatment of jaundice made up 93,3%.
Conclusions. Application of the current investigation methods (US, ERCP, PTHC, CT) permits to certify reliably the mechanical character of jaundice, reveal the cause and level of block, tumor lesion in the major duodenal papilla region and to assess the process prevalence. The choice of intervention type and volume at MJ depends primarily on MJ severity, patient’s general state, disease etiology as well as the level of obstruction zone and its expansion.
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734003, Respublika Tadzhikistan, g. Dushanbe, pr. Rudaki d. 139, Tadzhikskii gosudarstvennyi meditsin-skii universitet im. Abulai ibni Sino, kafedra khirurgicheskikh boleznei ¹1,
Makhmadov Farrukh Isroilovich
Makhmadov F.I. MD, an associate professor of the chair ¹1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Kurbanov K.M. Academician of AMS of the Republic of Tajikistan, MD, professor, a head of the chair ¹1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Nurov Z.H., a post-graduate student of the surgical diseases chair ¹1 of Avicenna Tajik State Medical University, Dushanbe.
Sobirov A.J. A post-graduate student of the chair ¹1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Gulahmadov A.D. A post-graduate student of the chair ¹1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.