Authors
Dryazhenkov G.I.1, Dryazhenkov I.G.2
1 GUZ Yaroslavl regional clinical hospital, Yaroslavl
2 Yaroslavl state medical University, Ministry of health of the Russian Federation, Yaroslavl
Abstract
The analysis of treatment of 64 patients with strictures and fistulas of intrahepatic bile ducts is presented. they performed bile-intestinal anastomoses with the use of replaceable hepatic drains. In 32 observations there were separated lobular ducts, in 15 – damage to three, and in 2 cases – four ducts. In 15 patients, coarse scar tissue of the preserved confluence arch of the hepatic ducts was revealed, their separation was carried out. The mouths of the intrahepatic ducts were sewn separately into the created intestinal ring of an isolated loop along the Ru. The mouths of the damaged lobular ducts were drained bilaterally, with the injury of three ducts, drainage was added by Smith. Scarring of the anastomoses was observed in 1 case. With stricture of four ducts, trigepaticoejunoanastomosis was formed due to crosslinking of 2 and 3 segmental ducts into a single mouth, transhepatic drainage was carried out through the intestinal ring, bile-intestinal anastomoses, isolated isoperistaltic enterostomy. Absorbable filaments were used. Endoscopic examination of hepaticoejuno and pancreatogastroanastomoses after pancreatoduodenal resections in the method of pancreatogastro-, gastroentero-and enterobiliary anastomoses with the use of a single intestinal loop in terms of 14 days to 1 year was carried out in 22 patients in order to study the healing time. Epithelialization of biliodigestive anastomoses ended by the 6th month. With bile leakage, the healing time increased to 10–12 months.
Keywords: intrahepatic biliary-enteric anastomosis, isolated intestinal loop according to Roux.
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