Tsatsanidi K N, Krendal' A P, Agaev R M, Sudarikova N V, Til'man N M, Sidorenko T P
Khirurgiia (Mosk). 1990 Oct(10):12-7.
The authors analyse the results of treatment of 185 patients with acute cholecystitis coexisting with affection of the bile ducts. In view of the high risk of operative treatment, endoscopic papillosphincterotomy was undertaken as the first stage in 83 patients and was completed by nasobiliary drainage in 46 of them, in still another 12 patients decompression was accomplished by means of laparoscopic cholecystostomy . Surgical intervention was carried out in the second stage after the patients recovered from a grave condition and obstructive jaundice and intoxication caused by purulent cholangitis were corrected. Another 90 patients underwent surgical operation without preliminary decompression in a postponed order (67 patients) and for emergency and urgent indications (19 patients) in vital conditions due to peritoneal phenomena. The changes in the bile ducts were corrected in them in the second stage, which reduced the risk of the development of postoperative complications. The authors emphasize the importance of two-stage treatment in coexistence of lesions and of a differential approach to the treatment of this contingent of patients according to the character and severity of the inflammatory process and the severity of the patients' condition.
作者分析了185例合并胆管病变的急性胆囊炎患者的治疗结果。鉴于手术治疗风险高，83例患者首先接受了内镜乳头括约肌切开术，其中46例随后进行了鼻胆管引流，另有12例患者通过腹腔镜胆囊造口术完成减压。在患者从严重病情中恢复、纠正化脓性胆管炎引起的梗阻性黄疸和中毒后，第二阶段进行手术干预。另外90例患者，67例延期手术、未进行初步减压，19例因腹膜现象处于危急状态而紧急手术，这些患者在第二阶段纠正了胆管病变，降低了术后并发症的发生风险。作者强调了针对病变共存进行两阶段治疗的重要性，以及根据炎症过程的特点和严重程度以及患者病情的严重程度，对这类患者进行差异化治疗的重要性。
