Cieľ práce: Retrospektívne zhodnotenie pooperačných a dlhodobých výsledkov vysokých biliodigestívnych anastomóz konštruovaných vlastnou technickou modifikáciou. Metóda: V práci je hodnotených 25 pacientov za dobu 8 rokov, ktorí mali našitú vysokú biliodigestívnu anastomózu pre klinicky manifestovaný obštrukčný ikterus alebo opakované ataky cholangoitíd. Ich podkladom bola 13x malignita hepatocholedochu, Ix striktúra hepatocholedochu po Kehrovej drenáži, Ix zápalová stenóza hepatocholedochu pri choledocholitiáze, 2x Mirizziho syndróm, 2x cysta hepatocholedochu, 4x striktúra hepatocholedochu po choledochoduodenoanastomóze 1 a hepatikolitiáza, Ix stav po cholecystogastrostomíi, Ix stav po kontúzii hepatocholedochu. Sledovaný bol bezprostredný pooperačný priebeh a komplikácie a dlhodobé prežívanie, prípadne príznaky intrahepatálnej cholestázy. Výsledky: Z 13 prípadov malignity hepatocholedochu bola 5x urobená jeho resekcia a 8x iba paliatívna anastomóza. Klasická hepatikojejunoanastomóza bola urobená 14x, anastomóza podľa Heppa-Couinauda 3x, Smithova teleskopická anastomóza 2x, Hutsonova klučka 4x, spojka na žlčovod v Rexovom recesse 2x. 2x bola pooperačná biliáma fistula, Ix mnohopočetné abscesy pečene, 3x exitus počas hospitalizácie na progresiu malignity a Ix hnisanie v rane. Dve pacientky po resekcii hepatocholedochu pre malignitu žijú 12 a 66 mesiacov. Z 12 pacientov po hepatikojejunoanastomózach pre benígnu striktúru ani jeden nemal známky pooperačnej cholestázy. Jedna pacientka zomrela za 13 mesiacov z kardiálnych príčin. Záver: Po paliatívnej hepatikojejunoanastomóze bez resekcie malignity je iba krátkodobé prežívanie. Iba po súčasnej resekcii hepatocholedochu možno očakávať ojedinelé dlhodobé prežívanie s otáznou kuratívnosťou. Konštrukcia hepatikojejunoanastomózy v našej modifikácii neviedla ani raz k biliárnej fistule. Oba prípady spojky na žlčovod v Rexovom recesse viedli k prechodnej biliárnej fistule. V prípade pochybností o dlhodobej funkcii spojky je výhodné použitie Hutsonovej kľučky.

Aim; A retrospective assessment of the post-surgical and long-term results of the high biliodigestive anasto¬ moses constructed using the authors' own technique modification. Methodology: This study evaluates 25 patient cases during an 8-year-period. The patients had high biliodigestive anastomosis affixed due to the clinically manifested obstructive icterus or due to repetitive attacks of cholangitides. The underlying causes of the attacks were malignancies of the ductus hepatocholedochus in 13 cases, a stricture of the ductus hepatocholedochus following the drainage according to Kehr in 1 case, an inflammative stenosis of the ductus hepatocholedochus during choledocholithiasis in 1 case, the Mirizzi syndrome in 2 cases, a cyst of the ductus hepatocholedochus in 2 cases, a stricture of the ductus hepatocholedochus following choledochoduodenoanastomosis in 4 cases, hepaticolithiasis in 1 case, a status after cholecystogastrostomy in 1 case, and a status after ductus hepatocholedochus contusion in 1 case. The immediate post-surgical progress and complications and the long-term survival rate, as well as any signs of the intrahepatic cholestasis, were assessed. Results: Out of the 13 cases of the hepatochodochus malignancy, in 5 cases it was resected and only in 8 cases a paliative anastomosis was performed. A classical hepaticojejunoanastomosis was performed in 14 cases. anastomosis according to Hepp-Couinaud in three cases, the Smith telescopic anastomosis in 2 cases, the Hutson loop in 4 cases, an anastomosis to the biliary duct in the recess of Rex in 2 cases. In 2 cases a post-surgical biliary fistula, once multiple liver abscesses, in 3 cases exitus due to the malignancy progress during hospitalization and once a suppurative inflammatory process in the wound appeared. Two female patients who underwent resection of the ductus hepatocholedochus due to a malignancy have been surviving for 12 and 66 months. None of the 12 patients who underwent hepaticojejunoanastomoses due to benign strictures had signs of the post-surgical cholestasis. One female patient died after 13 months following the surgery due to the cardial causes. Conclusion: The paliative hepaticojejunoanastomosis without malignancy resection is followed by a shortterm survival rate. Only following the simultaneous ductus hepatocholedochus resection, an exceptional case of a long-term patient survival may be expected, with a questionable curative effect. The hepatojejunoanastomosis construction according to our modification never caused a biliary fistula. The both cases of anastomoses to the biliary duct in the recess of Rex caused a transient biliary fistula. If in doubts about the long-term function of the anastomosis, the Hutson loop application appears to be of advantage.

Chirurgické oddelenie nemocnice Trenčín

Field surgery experience with hepaticojejunoanastomoses

Skúsenosti terénneho chirurgického pracoviska s hepatikojejunoanastomózami = Field surgery experience with hepaticojejunoanastomoses /

Field surgery experience with hepaticojejunoanastomoses /

Lit: 10

Souhrn: eng