Transhepatic drainage in surgery of the liver and bile ducts

Transhepatic drainage was used in 57 patients with high impassability of bile ducts. Indications to different variants of transhepatic draining are analysed, those ones being predominant when both ends of the drain are put onto the abdominal wall. The possible complications of the transhepatic drainage are described as well as the methods of prevention of cholangitis in the remote postoperative period.     

An approach to the right hepatic duct in treating high damage and cicatricial stricture of the bile ducts

There was proposed an operative access to the duct via the lateral end of transverse hepatic fissura, basing on the results of studying of the right hepatic duct anatomy. The method performed includes the right hepatic lobe mobilization, its fibrous capsule transsection along the transverse fissura in the direction toward right posterior sectorial duct, longitudinal transsection of the duct lateral wall along 1-2 cm with subsequent formation of laterolateral hepaticojejunoanastomosis. Method was tested in 9 patients with high damage and cicatricial stricture of biliary ducts, the result was positive.     

Transhepatic endoprosthesis of the bile ducts

The authors analysed the results of percutaneous transhepatic endoprosthetics of the hepaticocholedochus in 38 patients with incurable tumors of the organs of the hepato-pancreato-duodenal zone, complicated by obstructive jaundice. Nine different types of bile ejection blocking were distinguished, according to which the method and tactics of the endobiliary intervention were elaborated. Measures for the prevention of cholangitis, bleeding into the abdominal cavity, and hemobilia in the postoperative period are described in detail. The article shows the results recorded in flow-up periods of one to 11 months in 26 patients who had been subjected to endoprosthetics of the bile ducts and discharged from the clinic for out-patient treatment. Recurrence of obstructive jaundice caused by incrustation of the prosthesis was encountered only in 2 patients 4 and 9 months after the intervention. This allowed the authors to conclude that endoprosthetics of the hepaticocholedochus is very effective in the treatment of patients with obstructive jaundice of neoplastic etiology and to consider a transhepatic intervention an alternative of a surgical operation.     

高位胆管良性狭窄的原因和治疗

目的探讨高位胆管良性狭窄的原因和防治。方法回顾性总结分析高位胆管良性狭窄460例的病因和治疗方法。结果病因依次为肝胆管结石(383例)、高位胆管损伤(54例)、胆囊结石Mirizzi综合征(21例)、单纯良性狭窄(2例)。分别行肝叶或肝段切除；经肝剖开狭窄胆管，肝胆管或肝门胆管空肠吻合；肝门胆管狭窄切开整形后与空肠大口吻合；吻合口狭窄切开扩大吻合；肝门胆管狭窄切开整形后T管支撑等手术。效果满意，优良率为90．1％。结论高位胆管良性狭窄的主要原因是肝胆管结石(83．3％)和高位胆管损伤(11．7％)。肝叶或肝段切除，或联合肝内胆管或肝门胆管空肠大口吻合是治疗肝胆管结石并肝胆管狭窄的有效方法。高位胆管损伤初期修复后较易发生胆管或吻合口狭窄，再次修复以胆管空肠Roux-en-Y大口吻合术效果最好。强调重在预防，在行胆道手术时避免胆管损伤。     

Surgical treatment of injuries and cicatricial strictures of the bile ducts using changeable transhepatic drainage

Results of 62 reconstructive and restorative operations performed on 47 patients with scarry strictures and injuries of main bile ducts are analyzed. A group of 17 patients was chosen, a spare transhepatic drain being used in 18 operations. It was established that bougieurage, dilatation of the strictures and a continuous frame drainage with the stricture of hepaticocholedochus as long as 20 mm or recurrent strictures of hepaticojejunoanastomosis provided stabilization of scarring and epithelization of the stricture zone. A favorable result of the treatment is determined by the duration of the frame drainage not less than for 2 years.     

The combined treatment of cholangitis in patients with intraoperative damage and posttraumatic cicatricial stricture of the extrahepatic bile ducts

The result of treatment of 196 patients with cholangitis, occurred due to intraoperative trauma and posttraumatic cicatricial stricture of extrahepatic biliary ducts (EBD) was analysed. Methods of extracorporeal detoxication-hemosorption (in 53 observations), plasmapheresis (in 32), biohemosorption (in 21) were applied in the complex of treatment. The EBD decompression was conducted using endoscopic diathermocoagulation and bougienage of cicatricial stricture (in 56 patients) with introduction of a hidden drain (in 9) or nasobiliary catheter (in 47). In all the patients reconstructive and restorative operations were conducted. Postoperative complications occurred in 43 (22%) patients, 31 (15.8%) patients died. Stricture recurrence, necessitated reoperation conduction, was noted in 15 (7.6%) patients.     

Value of preoperative drainage of the bile ducts in obstructive jaundice]

Hepato-biliary surgery for obstructive jaundice is associated with high morbidity and mortality rates. Experimental and clinical studies on obstructive jaundice revealed endotoxaemia, coagulation disorders and depressed immune function. Many studies have been carried out to identify the operative risk factors. The serum bilirubin level seemed to be a significant factor. Biliary decompression via a percutaneous or endoscopic retrograde approach was therefore proposed to improve the surgical outcome. The first retrospective studies have suggested a reduction of morbidity and mortality. Subsequent randomized studies have not confirm the benefit of preoperative biliary drainage because of procedure-related complications. The article reviews the literature on preoperative biliary drainage and proposes the indications, choice of method and optimal duration of biliary drainage.     

External drainage and suture of the bile ducts following choledochotomy]

The authors report their experience with the use of a T-shape drainage in 258 choledochotomies, accomplished in 248 patients, and suturing of the common bile duct in 77 patients. The technic of preparation of a T-shape drainage, its fixation in the common bile duct and the postoperative management of patients with such drainages are described. The complications developed while using a T-shape drainage are analysed. Late sequelae of application of the drainage were taken into account after 219 operations, whereas in 163 patients intravenous cholangiography was performed after such drainage of bile ducts, the terms being longer than 3 years in 140 cases.     

Surgical correction of cicatricial stricture of the common bile duct

The authors describe their observation of 28 patients with extensive scarring stricture of the ductus hepaticocholedochus. The Sa?pol operation was performed in 21 patients, autonomic hepaticojejunostomy with transhepatic change drains in 7 patients. Results of the investigation in the postoperative period have shown the autonomic hepaticojejunostomy to have advantages over the Sa?pol technique.