Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital...
-
Upload
shavonne-martin -
Category
Documents
-
view
217 -
download
2
Transcript of Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital...
![Page 1: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/1.jpg)
Postcholecystectomic syndrome
Tashkent Medical Academy
The department of the faculty and hospital surgery
![Page 2: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/2.jpg)
•At first open cholecystectomy was performed in 1882 year by German surgeon Karl Langenbuch
•The first cholecystectomy in Russia – by Yu. F. Kossinskiy in 1886 year
•The first laparoscopik cholecystectomy was performed in 1882 year by German surgeon Erich Muhe
History
![Page 3: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/3.jpg)
•The gall stone disease has every 10 person at our planet
•At 5-40% patients, to which was performed the cholecystectomy, appear or save dyspeptic phenomenas, needing treatment.
EPIDEMIOLOGY
![Page 4: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/4.jpg)
![Page 5: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/5.jpg)
![Page 6: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/6.jpg)
Indications for cholecystectomy
• Chronic calculous cholecystitis
• Acute calculous cholecystitis
• Cholesterosis of the gall bladder
• Polyposis of the gall bladder
![Page 7: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/7.jpg)
Technique of the open cholecystectomy
![Page 8: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/8.jpg)
Technique of the laparoscopic cholecystectomy
Laparoscopic cholecystectomy is “gold standard” method of treatment of the gall stone disease
![Page 9: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/9.jpg)
Postcholecystectomic syndrome-
joined different pathological states and connected with
them clinic manifestations, checked the patients, to which the
cholecystectomy was performed .
![Page 10: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/10.jpg)
Main symptoms of the PChES
Pains in the abdomen (constant
or attacks) with jaundice
External bile fistula
Pains in the abdomen (constant or attacks)
without jaundice
Extended bile ducts
Narrow bile ducts
Steadfast jaundice
Periodically jaundice
![Page 11: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/11.jpg)
- Diseases and pathological atates of the bile-pancreatic system and BDM, not liquidated at the operation (choledocholithiasis, stenosing papillitis, stenosis of the CBD, cysts of the bile ducts and other); .
Classification
- Diseases and pathological atates of the bile-pancreatic system and BDM, directly connected with the operation (defeat of the bile ducts, strictures and deformations of the cult of the bladder’s duct).
- Diseases and pathological atates of the bile-pancreatic system and BDM, connected with the gall stone disease (chronic pancreatitis, hepatitis, gastritis and other).
- Diseases of other organs and systems, not connected with the bile system and cholecystectomy (diaphragmal hernia, USD, psychosteny and other)
- diseases, conducted with the functional defeats of the bile ducts and duodenum, appear as result of absence of the gall bladder: diskynesion of the bile ducts and Oddy’s sphincter.
![Page 12: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/12.jpg)
The reasons of the postcholecystectomic syndrome
•functional (to 60%)
•organically reasons (about 40%)
- changes of the bile ducts - changes of the GIP - defeats not connected with the GIP
![Page 13: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/13.jpg)
Reasons of the residual stones 1. Cholelithiasis wasn’t identified:
- Ignore the indicationts to the choledochotomy;- Hidden currency of the choledocholithiasis-Hard state of the patient; -Technical complications during the operation;- Mistakes in the diagnosis
2. Inferioity revision of the ducts
Reasons of the recidive stones1. Different pathological states, inducting the defect of bile evacuation2. Very big cult of the bladder’s duct or staying the part of gall bladder3. Presence of the alien objects in the ducts (ligatures, drainages, ascarides)
![Page 14: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/14.jpg)
Indications to the ERPChG
Jaundice or cholangitis in anamnesis or at the hospitalization
Increasing of the factors of hepatic testsPancreatitis in anamnesisExpansion of the common bile duct more
than 8 mm or 8 mm or presence cut-in in it by the US datas
Presence of the small concrements in the gall bladder and wide bladder’s duct by US
![Page 15: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/15.jpg)
• Wide bladder’s duct (more than 5 mm)
• Presence of small conrements in the gall bladder and
bladder’s duct
• Intraoperative visualisatiion of expansed bile duct at
the case of divergence with the data of before
operative US
• Impossibility of before operative performing of the
ERPChG and TTChG
Indications to the intraoperative cholangiography
![Page 16: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/16.jpg)
Technique of the intraoperative cholangiography
![Page 17: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/17.jpg)
Technique of the intraoperative cholangiography
![Page 18: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/18.jpg)
Choledocholithotomy
![Page 19: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/19.jpg)
Sewing of the choledotomic aperture and drainage of the choledoch
![Page 20: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/20.jpg)
Lithextraction from the CBD
![Page 21: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/21.jpg)
US
Clinic and diagnostic of the residual choledocholithiasis
Pain in the epigastria, left underrib
Mechanical jaundice
Bile fistulas
Acute cholangitis
X-ray contrasted methods
-ERPChG
-TTChG
- Fistulography
![Page 22: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/22.jpg)
Endoscopic retrograd pancreaticocholangiography
![Page 23: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/23.jpg)
TREATMENT
Not operable Operable
Washing Instrumental deleting
Solution
Miniinvasive Open
ERI TTEBI
![Page 24: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/24.jpg)
Removing the residual stones by the drainage
![Page 25: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/25.jpg)
Removing the residual stones by the endoscopic methods
![Page 26: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/26.jpg)
ERPChG before EPST
ERPChG after EPST
![Page 27: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/27.jpg)
Method of performing of the transcutaneus transhepatical endobiliar interventions
![Page 28: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/28.jpg)
RED of TPCh and descending of the concrements
![Page 29: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/29.jpg)
Reasons and clinic of the strictures of the bile ducts
Mechanical jaundice
Acute cholangitis
Bile fistulas
![Page 30: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/30.jpg)
Surgical reconstruction of the passibility of the bile ducts
At the LChE – conversion (passing to the open operation)
![Page 31: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/31.jpg)
Bile-digestive anastomosis
![Page 32: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/32.jpg)
Transhepatical endobiliar interventions at the strictures of the bile ducts
![Page 33: Postcholecystectomic syndrome Tashkent Medical Academy The department of the faculty and hospital surgery.](https://reader036.fdocuments.in/reader036/viewer/2022070401/56649f215503460f94c39b49/html5/thumbnails/33.jpg)
The tactic of general physician:
1. Collecting the patient’s complaints and
anamnesis
2. Conducting the US
3.Biochemical analysis
4.MRI-cholangiography
5. To refer in time for surgeon’s examination