The use of minimally invasive technologies of lithotripsy and antegrade hydraulic lithoextraction in the complex treatment of patients with choledocholithiasis complicated by obstructive jaundice and cholangitis
Abstract
Actuality. Сholedocholithiasis is one of the most common
complications of cholelithiasis. The gold standard for the treatment of
choledocholithiasis at the present stage is minimally invasive retrograde
endoscopic and videolaparoscopic methods of treatment. However, according to
various authors, the incidence of so-called «difficult choledocholithiasis»,
when the above methods cannot be applied technically or are ineffective, ranges
from 10 to 15% cases of choledocholithiasis.
Aim. To evaluate the effectiveness of the use of minimally
invasive technologies of lithotripsy and antegrade hydraulic lithoextraction in
the complex treatment of patients with choledocholithiasis complicated by
obstructive jaundice and cholangitis.
Material
and methods. In the main
group, consisting of 18 patients with choledocholithiasis complicated by
obstructive jaundice and cholangitis, а complex treatment was carried out using
minimally invasive technologies of lithotripsy and hydraulic antegrade
lithoextraction. In the comparison group, which included 35 patients with
choledocholithiasis complicated by obstructive jaundice and cholangitis,
complex treatment was carried out without the use of minimally invasive
lithotripsy technologies and hydraulic antegrade lithoextraction.
Results. During treatment, patients in both groups
demonstrated statistically significant decrease in laboratory parameters of
bilirubinemia, cytolysis and cholestasis against the background of the
elimination of clinical manifestations of obstructive jaundice. At the same
time, in the comparison group, there were statistically significant post-inflammatory
strictures and cicatricial stenoses of the choledochus. The main proportion of
these complications accounted for laparotomic interventions, such as external
drainage of the choledochus according to Ker and Vishnevsky, which were avoided
in the main group due to the use of minimally invasive lithotripsy technologies
and antegrade hydraulic lithoextraction.
Conclusion. Minimally invasive technologies of lithotripsy and
antegrade hydraulic lithoextraction are safe alternatives to traditional methods
of lithoextraction and can be recommended for use in patients in whom
video-laparoscopic and retrograde endoscopic lithoextraction are ineffective,
especially in the case of cholangitis as a risk factor for the development of
post-inflammatory strictures and cicatricial stenosis of the choledochus.
Keywords:choledocholithiasis; minimally invasive lithotripsy; antegrade hydraulic lithoextraction; obstructive jaundice; cholangitis
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Tseimakh A.E., Kurtukov V.A., Mishchenko A.N.,
Tepluhin V.N., Shoikhet Ya.N., Tseimakh M.E. The use of minimally invasive
technologies of lithotripsy and antegrade hydraulic lithoex-traction in the
complex treatment of patients with choledocholithiasis complicated by
ob-structive jaundice and cholangitis. Clinical and Experimental Surgery.
Petrovsky Journal. 2023; 11 (2): 34–40. DOI: https://doi.org/10.33029/2308-1198-2023-11-2-34-40
(in Russian)
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