Хирургическое лечение желчно-каменной болезни (обзор литературы)

Аннотация

В статье описаны современные методы диагностики и лечения острого холецистита и его осложнений при желчнокаменной болезни. В литературе данные, посвященные проблеме лечения холедохолитиаза, разноречивы. Вопрос оценки эффективности различных технологий лечения остается открытым и требует дальнейшего более углубленного изучения. Внедрение новых методик и технологий в лечение пациентов с холедохолитиазом не только не принесло ясности в решение вопросов, касающихся тактики лечения таких пациентов, но, и наоборот, усилило противоречия. 143 БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ | ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ | JOURNAL OF BIOMEDICINE AND PRACTICE №4 | 2021 Ключевые слова: желчнокаменная болезнь, холецистит, холецистэктомия, эндоскопические методы. САЙДУЛЛАЕВ Зайниддин Яхшибоевич РАХМАНОВ Косим Эрданович Самарқанд Давлат Тиббиёт Институти, Ўзбекистон Давлатов Салим Сулайманович Бухоро Давлат Тиббиёт Институти, Ўзбекистон ЎТ ТОШ КАСАЛЛИГИНИНГ ХИРУРГИК ДАВОЛАШ УСУЛЛАРИ (АДАБИЁТЛАР ШАРҲИ) АННОТАЦИЯ Мақолада ўт-тош касаллигидаги ўткир холецистит ва унинг асоратларининг замонавий ташхислаш ва даволаш усуллари баён қилинган. Адабиётларда холедохолитиазни даволаш муаммоларига бағишланган маълумотларда қарама – қарши қарашлар мавжуд. Даволашнинг турли хил технологиялари самарадорлигини баҳолаш масалалари ҳали ҳамон очиқ ва янада чуқурроқ изланишларни талаб этади. Холедохолитиаз билан беморларни даволашда замонавий усуллар ва технологияларнинг қўлланилиши ушбу тоифадаги беморларни даволаш тактикасига доир саволларга аниқлик киритиш ўрнига мавжуд қарама – қаршиликларни янада кучайишига олиб келди. Калит сўзлар: ўт тош касаллиги, холецистит, холецистэктомия, эндоскопик усуллар. Currently, gallstone disease (GSD) occupies a leading position in the structure of diseases of the organs of the hepatobiliary system. It has not only great medical, but also social significance, since the number of patients of young and working age is steadily increasing from year to year. In recent years, there has been a tendency towards an increase in the incidence of cholelithiasis throughout the world, including in Uzbekistan. Thus, the problem of treatment of gallstone disease and its ductal complications is one of the most urgent for modern surgery of the biliary tract [5, 17]. Today GSD occurs in more than 10% of the world's population. According to a number of authors, the prevalence of cholelithiasis in certain regions of the world can reach 10-40%, and over the past decades, the number of patients with cholelithiasis has doubled [28]. So, in the countries of Europe and North America, cholelithiasis is detected in 10-15% of the population under the age of 40, over 40 - already in 15-20%, and after 70 years in almost 50% [16]. With an increase in life expectancy, the number of elderly and senile patients who, in addition to gallstone disease, also have no less dangerous concomitant diseases, also increases. Thus, in 73- 76% of such patients, the course of cholelithiasis is complicated by various severe concomitant diseases, which sharply worsen the results of treatment [13]. Simultaneously with the increase in the overall incidence of cholelithiasis, the number of its complicated forms also increases. Among all complications of gallstone disease, special attention should be paid to choledocholithiasis, stenosing duodenal papillitis and their combination. Success in the treatment of patients with various complicated forms of cholelithiasis is also largely due to the determination of the optimal timing of treatment, the nature of therapeutic measures and a tactical approach [5, 22]. However, at present this problem remains unresolved, as evidenced by the huge variety of approaches used using combinations of conservative and surgical methods of treatment. For the first time open choledochotomy was successfully performed in 1889 by J. Thomston. From the end of the 19th century until the 70s of the last century, open choledocholithotomy remained the only surgical method for treating choledocholithiasis [21]. Even today, despite the extensive introduction of minimally invasive technologies and methods of treating choledocholithiasis, traditional laparotomic choledocholithiotomy remains relevant. Many surgeons still prefer this technique today. The wide surgical access provides comfortable conditions for performing absolutely all types of interventions on the gallbladder and 144 БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ | ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ | JOURNAL OF BIOMEDICINE AND PRACTICE №4 | 2021 bile ducts in case of cholelithiasis, choledocholithiasis, stricture of the terminal section of the common bile duct and other pathology of the biliary tract and provides the possibility of one-step resolution of this pathology. Open choledocholithotomy is characterized by a lower percentage of iatrogenic injuries of the bile ducts and vascular structures compared to minilaparotomic and laparoscopic interventions [15, 23]. Despite all its advantages, at the present time,