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Stenosis of the bile ducts main Gastroenterology is one of the most urgent and complex issues. An increase in the incidence of this disease in recent years due to the increased surgical activity of gallstones.
Most bile duct stenosis occurs as a result of intraoperative damage to the biliary tract (cholecystectomy from open cholecystectomy, mini-access laparoscopic cholecystectomy) during a gallbladder surgery.
The stricture distinguishes the common bile duct, the common bile duct, and the common hepatic duct by its origin. Bile duct stenosis may be partially or completely depending on the degree of patency.
There are three main groups of causes of bile duct stenosis: traumatic, inflammatory, and neoplastic. Traumatic stricture of the bile ducts usually develops as a result of intraoperative lesions of the bile ducts, endoscopic manipulation, gastric resection, transplantation, and liver resection during cholecystectomy.
To this group belongs scar contraction biliodigestive anastomosis, superimposed on the obstruction of the biliary tract, abdominal injuries. Intraoperative damage to the bile ducts, as a rule, will take place under difficult conditions of surgery: the patient is in a serious condition, emergency surgery, bleeding into the abdominal cavity, the presence of severe swelling and pus in the area of surgical intervention, so the presence of obesity and .
In these cases are not included. Evaluation of the laser electrocoagulator and others Surgeon needling or damage to the anatomical structure of the bile ducts, or their intersection.
In case of complete ligation or junctional choledoch bile duct stenosis developed in the early postoperative period; With partial ligation or injury – within 2 to 6 months; Obliteration of biliodigestive anastomosis usually occurs within 1 year from the date of imposition.
Inflammatory stenosis of the bile ducts, sclerosing cholangitis, chronic pancreatitis, ulcer, low 12 duodenal ulcer, parasitic liver disease (echinococcosis, opistorhoze), stones Bedsores, fixed cystic duct, and so when the walls of the ducts cause sores. D. by the appearance
Tumor strictures of the bile ducts are found in cancer of the extrahepatic biliary tract, cancer of the gallbladder, metastatic lesions of the liver and gated hepatoduodenal ligament. In rare cases, bile duct strictures are caused by congenital anatomical anomalies of the biliary tract, radiation therapy.
The state of stenosis is the expansion and thickening of the walls of the bile ducts, arranged above the narrowing. Bile stagnates in its sealed ducts, viscous, easily becomes infected, creating the necessary conditions for the formation of gallstones. Long-term violation of the outflow of bile from the liver in unrecognized and unresolved obstruction contributes to the development of secondary biliary cirrhosis and portal hypertension.
Findings depend on the type of strictures to the bile ducts and the extent of damage. In the case of a complete junction of stenosis of the bile duct, clinical signs develop already in 3-7 days: there is pain, fever, jaundice, bile flow, right abdomen, indicating the formation of external biliary fistula.
There are dyspeptic symptoms – nausea, vomiting, loss of appetite, flatulence; in some cases, developing intestinal obstruction. With bile duct injury in the abdominal cavity, biliary biliary peritonitis develops, while abscesses can form subhepatic.
When compressing choledoch or dressing fever, chills, epigastric pain, increased phenomenon of cholestatic jaundice and cholangitis with stool and dark urine, itching.
If cholangitis and jaundice are partial signs of bile duct stenosis within a few months, there is a mild course reminiscent of SARS. Untimely removal of obstruction leads to the formation of stenosis of the bile ducts, abdominal abscesses, sepsis, biliary cirrhosis, portal hypertension, gastrointestinal bleeding, liver failure.
In most cases, the development of bile duct stenosis is associated with the clinical manifestations of surgery. Biochemical liver tests are characterized by levels of bilirubin, transaminases, alkaline phosphatase activity.
The primary method of visualization of biliary duct stenosis is ultrasound, through which it reveals its severity and level of obstruction. Scintigraphy of the hepatobiliary system is used for the detection of biliary passage. It is possible to determine the causes of MRI of the biliary tract, localization, extent, length of stenosis, development of secondary complications.
It is highly informative when bile duct strictures are percutaneous transhepatic cholangiography, relaxation duodenography, retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography. Install drainage for diagnostic and therapeutic purposes, can be used laparoscopy, which allows to examine the abdominal cavity, remove bile residues.
Prolonged biliary obstruction Severe consequences bile duct stenosis require mandatory removal of endoscopic or open surgical technique. In the preoperative period for infusion therapy, antimicrobial therapy, removal of intoxication, taking into account the data of the appendix bile and blood.
There are percutaneous or endoscopic balloon dilatation, endoscopic probing strictures, and choledochal endoscopic stent for minimally invasive methods of treatment strictures of the bile ducts. A particular application of these methods is the possibility of using when there is a high rate of restenosis of the bile ducts, such as upper and unexpanded stenosis.
The impossibility of minimally invasive removal in bile duct stenosis, horse excision and reconstructive operations have applied to stricture. In surgical practice, surgical anastomosis was most frequently performed at the proximal end of the common bile duct and between the jejunal loop (holedohoeyunoanastomosa) or the liver canal and jejunum (geatikoeyunoanastomosa).
In some cases, to relieve jaundice, the first step is carried out by external drainage of the biliary tract, transhepatic percutaneous drainage, drainage nasobiliarnogo decompression of the bile ducts at RPHG, and then, in the cold winter, reconstructive surgery is carried out. Removal of bile duct stenosis does not reduce portal hypertension, it requires more portocaval bypass.
