Приводятся данные клинических наблюдений хирургического лечения больных с механичеcкой желтухой с использованием различных диагностических и оперативных парадигм. На основании полученных данных авторы рекомендуют индивидуальный подход к выбору тактики хирургического лечения в каждом конкретном случае, выполнение операции в так называемом холодном периоде, обязательный учет возможного высокого операционного и анестезиологического риска, в том числе и возраста пациентов. Этапность проведения оперативных вмешательств у больных с механической желтухой и холедохолитиазом является преимущественным
способом эффективного хирургического лечения. Выполнение при этом на втором этапе лапароскопической, а не открытой холецистэктомии предупреждает формирование у пациентов печеночной недостаточности в послеоперационном периоде.
Indications for laparoscopic cholecystectomy (LCE) performing continue to be expanded
for more than 25 years since its first performance by a French surgeon F. Dubois. Endovideosurgical
and, especially, laparoscopic technologies are positioned strongly on a leading places in the choice
of treatment management of patients in various fields of surgery. They are also progressively spread
to related medical specialties giving them a new impulse for accelerated development.
After results of long-term clinical follow-up and surgical treatment of patients with hepatic insufficiency
(HI) analysis we came to the conclusion that in some cases this pathology develops as a result
of ineffective treatment of patients with obstructive jaundice (OJ). The authors reported clinical observations about the surgical treatment
of patients with OJ using a variety of diagnostic and operational paradigms. 164 patients at age 32 to
72 years were under the supervision — they were operated because of MJ during the last three years.
According to the treatment result, all patients were retrospectively randomized into 2 groups: the
1st group patients (n=101, 61.6%) were undergone two-stage surgery with endoscopic papillosphincterotomy
(EPST) on the first and LCE in the second stage of surgical treatment. 63 patients (38.4%)
out of the 2nd group were forced to carry out an open surgery for choledocholithiasis in the first stage
and/or open cholecystectomy (OCE) in the second stage of the performed surgical treatment.
The efficacy of the treatment was estimated during the first 7–10 days immediately after the surgery
and 3 months after patients left surgical department.
