Authors
Dryazhenkov G.I.1, Dryazhenkov I.G.2, Balnykov S.I.2, Shirshov O.I.1
1 Yaroslavl regional clinical hospital, Yaroslavl
2 Yaroslavl state medical University, Yaroslavl
Abstract
Rationale: Cystic transformation of the bile ducts is rare. The search for optimal methods of surgical treatment of transformed cysts continues.
Objective: To analyze the surgical treatment of patients with cystic transformation of the bile ducts and the choice of optimal methods of surgical correction depending on the localization of cysts.
Material and methods: The experience of surgical treatment of 15 women and 1 man with cystic transformation of the bile ducts is presented. The main diagnostic methods were ultrasound, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography.
Results: Results: 2 patients with Karoli’s disease underwent resection of the left lobe of the liver (1) and removal of segments 2 and 3 plus resection of the hepaticocholedoch cyst using isolated jejunoanastomosis by Roux (1). Invagination of fragments of partially excised hepatic duct cysts was formed through an iatrogenic defect of the lobar duct wall in 2 patients. One patient underwent resection of the lobar ducts and hepaticocholedoch with invaginate, the other underwent desinvagination through duct incisions. For cysts of the ducts of subhepatic localization, excision of their walls, bigepaticoejunostomy into the intestinal ring (1), hepaticoejunostomy according to Roux (8) were used. Cystoejunostomy into the intestinal loop according to Brown was performed in 2 patients. 2 patients had membranous intra-flow septa in the distal parts of the dilated lobar ducts. Postoperative complications: destructive pancreatitis, subhepatic biloma. There were no fatalities. In the long-term period, 2 patients were re-operated: with stricture of the left hepatic duct (1) and Brown cystoenteroanastomosis stenosis (1). In 2 patients, 13 and 15 years after complex excision of cysts with hepaticoejunostomy, extensive cancer infiltrate of the subhepatic region was detected. Postoperative complications: destructive pancreatitis, subhepatic biloma. There were no fatalities. In the long-term period, 2 patients were re-operated: with stricture of the left hepatic duct (1) and Brown cystoenteroanastomosis stenosis (1). In 2 patients, 13 and 15 years after complex excision of cysts with hepaticoejunostomy, extensive cancer infiltrate of the subhepatic region was detected.
Conclusion: We use active surgical tactics: complete excision of the cyst walls, the creation of a hepaticoejunoanastomosis using an isolated intestinal loop according to Roux and a resection technique for single-lobar cyst lesion.
Keywords: cystic transformation of the bile ducts, Karoli’s disease.
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