Результаты лечения больных с желчеистечением после холецистэктомии

Аннотация

To develop surgical tactics and to improve results of treatment of patients with a leakage in the next postoperative period after a holetsistektomiya. Material and methods of research. We analysed results of surgical treatment of 2247 patients who trans- ferred a holetsistektomiya in clinic of SamMI in the period of 2010 – 2014 year. In the early postoperative period it were marked out leakage at 52 (2,31%) the patient. For the purpose of identification of a leakage applied the following methods of research: Ultrasonography, KT, fi-stulografiya, ERPHG. Results. For an assessment of a postoperative leakage used the modified classification of L. Morgenstern (2006), for definition of damages of magistral bile ducts used E.I. Galperin's classification (2002). Consid-ered not only a daily output of bile on a drainage of an abdominal cavity, but also liquid congestion volume in projections of a bed of a gall bladder, and also availability of free liquid in an abdominal cavity according to ultrasonography. Conclusions. Leakage frequency after holetsistektomiya makes 0,74% (after THE – 2,44%, after LHE – 1,08%, after MHE – 2,47%). "Small" damages of bilious channels and 25,26% cases – damage of the main bilious channels were sources of a postoperative leakage in 54,72% of supervision. In 20,02% cases the source isn't established. Ultrasonography is an initial method of diagnostics of a postoperative leakage. At a leakage of 1 degree, lack of signs of irritation of a peritoneum and symptoms of intoxication it is necessary to adhere to tactics of active dynamic supervision. At a leakage of 2-3 degrees repeated intervention – a lapa-roscopy, a laparotomy is shown.