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, patients general state, disease etiology as well as the level of obstruction zone and its expansion.

Keywords: mechanical jaundice, bilary ducts decompression, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography
p. 113 122 of the original issue
References
  1. Bashilov VP, Brekhov EI, Malov IuIa, Vasilenko OIu. Sravnitel'naia otsenka razlichnykh metodov v lechenii bol'nykh ostrym kal'kuleznym kholetsistitom, oslozhnennym kholedokholitiazom [Comparative assesment of different methods in the treatment of patients with acute calculous cholecystitis complicated by choledocholithiasis]. Khirurgiia. 2005;(10):4045.
  2. Vetshev PS, Shulutko AM, Prudkov MI. Khirurgicheskoe lechenie kholelitiaza: nezyblemye printsipy, shchadiashchie tekhnologii [Surgical treatment of cholelithiasis: the immutable principles, sparing technologies]. Khirurgiia. 2005;(8):9193.
  3. Maistrenko NA, Andreev AL, Stukalov VV. Programmnyi podkhod v lechenii bol'nykh zhelchnokamennoi bolezn'iu s vysokim operatsionnym riskom [The program approach in the treatment of patients with cholelithiasis with high operative risk]. Annaly Khirurg Gepatol. 2002;(1):12728.
  4. Kononenko SN, Limonchikov SV. Diagnostika mekhanicheskoi zheltukhi i puti povysheniia effektivnosti miniinvazivnykh tekhnologii, napravlennykh na ee likvidatsiiu [Diagnosis of obstructive jaundice and ways to improve the efficiency of minimally invasive technologies aimed to its elimination]. Khirurgiia. Zhurnal im NI Pirogova, 2011;( 9):410.
  5. Ermolov AS, Guliaev AA, Ivanov PA. Maloinvazivnye metody v lechenii ostrogo kholetsistita [Minimally invasive techniques in the treatment of acute cholecystitis]. Khirurgiia organov gepatopankreatobiliarnoi zony. Moscow, RF: 2000. 146 p.
  6. Shevchenko IuL, Vetshev PS, Stoiko IuM, Levchuk AL, Bardakov VG, Stepaniuk IV. Optimizatsiia diagnosticheskogo algoritma i povyshenie effektivnosti maloinvazivnykh khirurgicheskikh vmeshatel'stv pri mekhanicheskoi zheltukhe [Optimizing of the diagnostic algorithm and effectiveness of minimally invasive surgical treatments for obstructive jaundice]. Annaly Khirurg Gepatol. 2008;13(4):96101.
  7. Divilin V.Ia., Kuleshov E.V., Bulgakov G.A. i dr. Osobennosti diagnostiki i khirurgicheskogo lecheniia zhelchnokamennoi bolezni u lits s vysokim operatsionnym riskom [Features of diagnosis and surgical treatment of gallstone disease in patients with high operative risk]. Annaly Khir Gepatol. 2002;(1):104.
  8. Foley WD, Quiroz FA. The role of sonography in imaging of the biliary tract. Ultrasound Q. 2007 Jun;23(2):12335.
  9. Hong J, Dohi T, Hashizume M, Konishi K, Hata N. An ultrasound-driven needle-insertion robot for percutaneous cholecystostomy. Phys Med Biol. 2004 Feb 7;49(3):44155.
  10. Akhan O, Akinci D, Ozmen MN. Percutaneous cholecystostomy. Eur J Radiol. 2002 Sep;43(3):22936.
  11. Bakkaloglu H, Yanar H, Guloglu R, Taviloglu K, Tunca F, Aksoy M, Ertekin C, Poyanli A. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol. 2006 Nov 28;12(44):717982.
  12. Spalding DR. Pancreatic and periampullary cancers: treatment and outcome. Br J Hosp Med (Lond). 2006 Jan;67(1):1420.
  13. Berman M, Nudelman IL, Fuko Z, Madhala O, Neuman-Levin M, Lelcuk S. Percutaneous transhepatic cholecystostomy: effective treatment of acute cholecystitis in high risk patients. Isr Med Assoc J. 2002 May;4(5):33133.
  14. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg. 2001 Oct;234(4):54958.
  15. Laing FC, Jeffrey RB, Wing VW. Improved visualization of choledocholithiasis by sonography. AJR Am J Roentgenol. 1984 Nov;143(5):949-52.
Address for correspondence:
734003, Respublika Tadzhikistan, g. Dushanbe, pr. Rudaki d. 139, Tadzhikskii gosudarstvennyi meditsin-skii universitet im. Abulai ibni Sino, kafedra khirurgicheskikh boleznei 1,
e-mail: fmahmadov@mail.ru,
Makhmadov Farrukh Isroilovich
Information about the authors:
Makhmadov F.I. MD, an associate professor of the chair 1 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 1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Nurov Z.H., a post-graduate student of the surgical diseases chair 1 of Avicenna Tajik State Medical University, Dushanbe.
Sobirov A.J. A post-graduate student of the chair 1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Gulahmadov A.D. A post-graduate student of the chair 1 of surgical diseases of Avicenna Tajik State Medical University, Dushanbe.
Contacts | ©Vitebsk State Medical University, 2007-2023