Late results of endoscopic papillosphincterotomy in patients with non-neoplastic diseases of the common bile duct

An investigation of long-term results of treatment of 226 patients has shown that endoscopic papillosphincterotomy is a highly effective method of treatment of patients with cholelithiasis and stenosis of the major duodenal papilla. The complex use of the surgical and endoscopic methods of treatment gave most favorable results.     

Use of endoscopic papillosphincterotomy in the treatment of acute pancreatitis

The authors describe results of using endoscopic papillosphincterotomy in 100 patients with acute pancreatitis. Methods of endoscopic papillosphincterotomy and endoscopic papillosphincterowirsungotomy are presented. The effectiveness of the treatment was 96%. Operative procedures on emergency made up 1%, lethality-1%, complications-3% of the cases.     

Endoscopic papillosphincterotomy in patients with acute cholecystitis and lesions of the common bile duct

The authors analyse treatment of 115 patients who were admitted for acute cholecystitis with involvement of the bile ducts which manifested itself as a rule, as obstructive jaundice and cholangitis. Endoscopic papillosphincterotomy (EPST) was conducted as the first stage of treatment in 83 patients, as the second stage after cholecystectomy or laparoscopic cholecystotomy in 30, and during the surgical intervention in 2 patients. Experience shows that treatment of this contingent of patients in two stages is advisable. In emergency operations for acute cholecystitis, when the revealed abnormalities in the hepaticocholedochus cannot be corrected adequately due to the patient's severe condition or marked inflammatory changes in the region of the hepatoduodenal ligament, the operation should be completed by drainage of the common bile duct and antegrade or retrograde EPST should be performed in the post-operative period. In the presence of obstructive jaundice and acute suppurative cholangitis, when there is a high operative risk, EPST should be undertaken as an emergency intervention ensuring timely decompression and cleansing of the bile ducts. In 37.3% of patients EPST was conducted by an atypical method due to the high operative risk, as a result the efficacy of the endoscopic operation increased to 93.3%.     

Use of endoscopic and surgical methods in the treatment of patients with acute cholecystitis

Laparoscopic gallbladder drainage (LGBD) was undertaken to arrest acute inflammation in 121 patients suffering from acute cholecystitis and serious concomitant diseases. Their ages ranged from 30 to 89 years. Cholecystectomy was carried out in 78 patients after complete abatement of the inflammatory process. When the risk of a radical operation was very high treatment was restricted to cleansing of the gallbladder cavity (CGBC). In 9 patients stones were removed from the gallbladder through a cholecystostoma, formed during LGBD, using a choledochoscope. Cleansing cholecystostomy under local anesthesia was conducted in 19 cases. Fifteen patients who were treated by CGBC had choledocholithiasis; they were subjected to endoscopic papillosphincterotomy. The death rate was 1.6%.     

Improvement of endoscopic treatment of the acute cholecystitis

Treatment results of 763 patients with acute cholecystitis were analyzed. Destructive forms of the disease was diagnosed by the ultrasound examination in all cases. Choledocholithiasis was diagnosed in 35 (4.6%), choledocholithiasis with papilla Vatery stricture was in 9 (1.2%) patients and isolated papilla Vatery stricture was registered in 5 (0.7%) patients. All patients were attempted to treat laparoscopically with the use of original "Device for antegrade papillotomy" and "Method of antegrade bipolar papillosphincterotomy". Authors state, that a final decision about the possibility of endoscopic treatment of the acute cholecystitis can be made after detection of anatomical structures of the Calo triangle. By complicated forms of the disease a one-stage laparoscopic treatment should be preferred. Endoscopic papillosphincterotomy should be performed only by the enblocked concrement of the papilla Vatery.     

超声引导下经十二指肠镜治疗老年胆总管结石

目的探讨超声引导下经十二指肠镜治疗老年胆总管结石的临床价值。方法对48例60岁以上胆总管结石患者行超声引导下经十二指肠镜乳头肌切开及取石术（EST）。术后经超声及X线下内镜逆行性胆胰管造影（ERCP）观察治疗效果。结果48例患者中超声引导下经十二指肠镜取石一次成功43例，二次取石成功3例，共取出完整结石51粒，结石大小为0．8～2．1cm，取石总成功率为95．83％（46／48）。结论超声引导下经十二指肠镜治疗胆总管结石不需麻醉、创伤小、痛苦少、术后恢复快，取石成功率高,对老年患者尤其是一种安全有效的治疗方法。     

Diagnosis, surgical treatment procedure and results in acute cholecystitis in young patients

Among the patients with acute cholecystitis, those at the age of 20-45 years account for 12.6%. Of them, 50.9% develop complications: choledocholithiasis, obstructive jaundice, cholangitis, pancreatitis etc. The main method for treatment of the patients is the operation within 24-48 hr from the moment of their admission with intraoperative diagnosis of pathology of the extrahepatic bile ducts. There were no lethality, postoperative complications were noted in 9.3% of the patients.     

Surgical treatment of acute cholecystitis in patients with diabetes mellitus

The tactics of early operations for acute cholecystitis in patients with diabetes mellitus gives substantially better results of surgery. In the recent years the incidence of complications in this group of patients has been 20.3%, lethality--6.3%. Control of the carbohydrate metabolism must be made at short terms. It is the operation in combination with the rational insulin therapy which gives the correction of the carbohydrate metabolism.     

An endoscopic method of the treatment of complicated acute calculous cholecystitis

Surgical treatment of acute cholecystitis attended by an affection of the extrahepatic bile ducts often leads to severe complications, particularly in elderly and old-aged patients, the mortality rate in such cases reaches 5-12%. The authors developed and introduced into practice a method of endoscopic treatment of acute combined diseases of the gallbladder and bile ducts, which included endoscopic papillotomy, antegrade catheterization of the gallbladder (laparoscopic cholecystostomy, transhepatic gallbladder drainage), antegrade perfusion with antiseptics under pressure, and various types of ante- and retrograde lithotripsy. Endoscopic method of treatment of combined diseases of the gallbladder and bile ducts makes it possible to remove the acute inflammatory process and in some cases may be an alternative to an emergency surgical operation.     

急性危重胆囊炎的微创治疗

目的:探讨急性危重胆囊炎患者的微创治疗方案,为其研究提供可参考依据。方法:本研究共纳入80例诊断为急性危重胆囊炎的患者作为研究对象,均予以经皮经肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGBD),根据行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的时间分为限期组(72 h内)与延期组(6周后),对比两组患者围手术期差异、临床疗效及并发症情况等。结果:限期组术中失血量、引流量、引流时间、进食时间及手术时间均明显低于延期组,差异有统计学意义(P0.05)。延期组中转开腹的比例明显高于限期组,差异有统计学意义(P0.05)。结论:在有效控制感染及病情稳定后,急性危重胆囊炎患者行PTGBD联合限期LC可得到更好的疗效,限期LC降低了围手术期引流时间及并发症发生率,且利于术后机体功能恢复。     

腹腔镜胆囊切除术治疗急性胆囊炎的比较分析

目的探讨胆囊炎急性发作时,实施腹腔镜胆囊切除术治疗的时间早晚对手术特点、手术技巧及手术结果的影响。方法对最近1年中我院54例急性胆囊炎腹腔镜胆囊切除术的过程、结果进行回顾性对照分析。结果54例中急性发作后48 h内40例行急诊腹腔镜胆囊切除术,手术时间短,无转开腹者;48 h后者手术时间长,3例转开腹,中转率为21.43%（3/14）。结论急性胆囊炎急诊施行腹腔镜胆囊切除术是有益的和必要的。