复杂胆总管结石治疗经验回顾性分析

V. Grubnik, B. V. Evsikov, D. V. Gerasimov
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摘要

目标。评价各种方法治疗复杂胆总管结石的临床效果及应用。材料和方法。该调查于2018 - 2021年在敖德萨地区临床医院的基础上进行。回顾性分析了69例复杂胆总管结石患者的临床治疗结果。结果。复杂胆总管结石的治疗策略选择必须最大限度地个体化,并取决于患者的状态和并发疾病的存在。在病情严重的病人,治疗必须从经肝胆管引流开始。它可以消除胆管炎的迹象,改善病人的状态,并为他准备更复杂的手术干预。结论。在复杂的胆总管结石中,为了降低胆血症水平,进行初步胆管引流的两阶段干预是有利的。在选择复杂胆总管结石的治疗策略时,必须考虑到患者的状态和年龄、是否伴有病理以及病程的临床解剖学特点(结石的尺寸、狭窄、胆总管憩室等)。延长内窥镜干预是最安全的选择。
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Retrospective analysis of experience of treatment of complex choledocholithiasis
Objective. Estimation of the clinical results application, concerning various methods of the complex choledocholithiasis treatment. Materials and methods. The investigation was conducted on the base of Odessa Regional Clinical Hospital during 2018 - 2021 yrs. Retrospective analysis of clinical results in treatment of 69 patients with complex choledocholithiasis was accomplished. Results. The tactics of treatment choice in complex choledocholithiasis must be maximally individualized and depend on a patient state and presence of concurrent diseases. In severe state of a patient the treatment must be started with transhepatic drainage of biliary ducts. It permits to eliminate the cholangitis signs, to improve a patient state and to prepare him to more complex operative interventions. Conclusion. In complex choledocholithiasis it is expedient to perform a two-staged interventions with preliminary drainage of biliary ducts for the cholemia level lowering. Tactics of treatment of complex choledocholithiasis must be selected, taking into account the patient state and age, presence of concomitant pathology and the clinic-anatomic peculiarities of the disease course (dimensions of calculi, stenosis, diverticulas of common biliary duct, etc). The extended endoscopic interventions constitute the most secure option.
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