Minimally-invasive technologies in the treatment of choledocholithiasis complicated by cholangitis and biliary sepsis

  • I. M. Deikalo State Institution «Zaporizhia Medical Academy of post-graduate education Ministry of Health of Ukraine», Zaporizhzhia, Ukraine
  • D. V. Osadchuk State Institution «Zaporizhia Medical Academy of post-graduate education Ministry of Health of Ukraine», Zaporizhzhia, Ukraine
  • O. I. Karel State Institution «Zaporizhia Medical Academy of post-graduate education Ministry of Health of Ukraine», Zaporizhzhia, Ukraine
  • M. B. Ganjalas State Institution «Zaporizhia Medical Academy of post-graduate education Ministry of Health of Ukraine», Zaporizhzhia, Ukraine
Keywords: cholecholithiasis, purulent cholangitis, biliary sepsis, septic shock, endoscopic retrograde pancreatic cholangiography, endoscopic papillomotorotomy

Abstract

Minimally-invasive endoscopic technologies are used in the treatment of patients with choledocholithiasis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014–2018, aged 65,5 ± 15,18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) – surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) – by needle. In all cases, subtotal papilloprotectomy was performed, supplemented by balloon sphincteroplasty. In the I group, the patients included patients with acute cholangitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock.

In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observe during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of cholangitis and biliary sepsis was noted.

References

Nichiatlo ME , Grubnik VV, Lurin IA at al. Video endoscopic diagnosis and minimally invasive surgical cholelithiasis. Medicine. 2013; 173–201.

Kolomіytsev VІ. Diagnosis and therapeutic transpulmonary intervention in patients with portal portal pathology. Klіnіchna khіrurhіya. 2017; 906 (10): 23–26.

Ogorodnik PV, Deynichenko AG, Boyko OG. Endoscopic surgery of distal occlusion of the common bile duct. Ukrayinskyy zhurnal maloinvazivnoyi ta endoskopichnoyi khirurhyyi. 2014; 18 (4): 19–22.

Agapov VK, Romanov VA, Aleksandrov BA, Aslibekov MA. The use of endoscopic ultrasound in the diagnosis of choledocholithiasis. Voyennomeditsinskiy zhurnal. 2006; 3: 41–43.

Klymenkov AV. Diagnostic and therapeutic tactics for mechanical jaundice complicated by acute cholangitis. PhD. 1985, Moscow. Russian Federation.

Maystrenko NA, Stukalov VV. Choledocholithiasis. St. Petersburg. 2000; 288.

Shalimov AA , Shalimov SA, Nichiatlo ME, Dumansky BV. Surgery of the liver and bile ducts. Kyiv. 1993; 507.

Altyyev BK, Nazarov FG, Vakkasov MK, Sadykov KT. Comprehensive treatment of purulent cholangitis in patients with non-tumor obstruction of the extrarenal bile ducts. Annaly khirurgicheskoy gepatologii. 1998; 3: 47–49.

Halperin EI. Chest strictures of the bile duct. Medicine, 1982; 194.

Zhuravlev VA. Transcathecal drainage with high scar strictures and traumatic damages of the anaphylactic gallbladder paths. Vestnik khirurgii. 1979; 6: 12–14.

Deleve LD. Dacarbazin toxity in murine liver cells: a model of hepatic endothelial injury and glutathione defence. J Pharmacol Exp Ther. 1994; 268 (3): 1261–1270.

Golstein P, Ojcius DM, Young JD. Cell death mechanisms and the immune system. Immunol Rev. 1991; 121: 29–65.

Akhaladze GG, Gelperin EI. Biliary sepsis. Khirurgiya. 1999; 9: 16–19.

Akhaladze GG. Purulent cholangitis: the issue of pathophysiology and treatment. Consilium medicum. 2003; 4: 11–15.

Halperin EI. Diseases of the biliary tract after cholecystectomy. Medicine. 1988; 186.

Ludwig J. Histopathology of primary sclerosing cholangitis. Philadelphia, 2000; 114.

Mitchell RM, Byrne MF. Biliary emergencies: pancreatitis, cholangitis, and more. Semin Gastrointest Dis. 2003; 14: 77–86.

Aleksandrov BA. Comparative evaluation of various diagnostic methods and surgical tactics for choledocholithiasis. PhD. 2007, Moscow. Russian Federation.

Ramirez FC, McIntosh AS, Dennert B, Harlan JR. Emergency endoscopic retrograde cholangiopancreatography in critically ill patients. Gastrointestinal Endoscopy. 1998; 47 (5): 368–371.

Published
2019-09-20
How to Cite
Deikalo, I. M., Osadchuk, D. V., Karel, O. I., & Ganjalas, M. B. (2019). Minimally-invasive technologies in the treatment of choledocholithiasis complicated by cholangitis and biliary sepsis. Modern Medical Technology, (3(42), 26-31. https://doi.org/10.34287/MMT.3(42).2019.10
Section
Original research