Procena funkcije holedohoduodenalne anastomoze u hirurškom lečenju benignih opstruktivnih oboljenja žučnih puteva
Sažetak
Apstrakt
Uvod/Cilj. Holedohoduodenalna anastomoza se uspešno primenjuje u hirurškom lečenju benignih bilijarnih opstrukcija. Međutim, smatra se da je povezana sa izvesnim procentom komplikacija, (holangitis i “sump” sindrom), kao posledice duodeno-bilijarnog refluksa, koji može postojati nakon njenog kreiranja. Cilj rada bio je procena efikasnosti, sigurnosti i tehnike izvođenja holedohoduodenalne anastomoze u terapiji distalnih benignih bilijarnih opstrukcija, u cilju utvrđivanja uticaja izbora indikacija i operativne tehnike na pojavu postoperativnih komplikacija. Metode. Prospektivnom studijom je obuhvaćeno 50 bolesnika operisanih zbog benignih bilijarnih opstrukcija, primenom holedohoduodenalne anastomoze. Analizom i komparacijom kliničke slike, biohemijskih parametara holestaze, ultrazvuka i parametara operativne tehnike, kao i analizom ranog postoperativnog perioda i detekcijom komplikacija, utvrđivani su efikasnost, sigurnost i kompetentnost holedohoduodenoanastomoze. Rezultati. Neposredne specifične postoperativne komplikacije, vezane za anastomozu, zabeležene su kod 12% bolesnika (uglavnom minorne hirurške komplikacije). Neposredno nakon kreiranja anastomoze, aerobilija kao indirektni znak duodenobilijarnog refluksa, registrovana je kod 91,7% bolesnika, ali se taj procenat do tridesetog dana smanjio na 16,70% i nije bio uvek praćen patološkim posledicama. Holangitis je potvrđen kod jednog (2%) bolesnika, kao i dehiscencija anastomoze (2%), dok “sump” sindrom nije detektovan u posmatranom periodu. Tranzitorni duodenogastrični refluks je identifikovan kod 6% bolesnika. Stopa intrahospitalnog mortaliteta bila je niska (4%), s obzirom na kompleksno stanje bolesnika podvrgnutih operaciji. Zaključak. Holedohoduodenalna anastomoza je jednostavna i efikasna metoda u lečenju benignih bilijarnih opstrukcija. Ozbiljne komplikacije moguće je izbeći pravilnim izborom indikacije i pažljivom operativnom tehnikom, zbog čega njihovo poznavanje mora biti deo osnovne edukacije svakog opšteg hirurga.
Reference
REFERENCES
Jeremić M. Biliary duct surgery. In: Jeremić M, editor. Special surgery 1, diagnostics and therapy. Niš: Faculty of Medicine, Universyti of Niš; 2001. P. 14/1‒14/5.
Pérez Fernández T, López Serrano P, Tomás E, Gutiérrez ML, Lledó JL, Cacho G, et al. Diagnostic and therapeutic ap¬proach to cholestatic liver disease. Rev Esp Enferm Dig 2004; 96(1): 60‒73. (English, Spanish)
Mitchell SA, Jacyna MR, Chadwick S. Common bile duct stones: A controversy revisited. Br J Surg 1993; 80(6): 759‒60.
Aramaki M, Ikeda M, Kawanaka H, Nishijima N, Tsutsumi N, Kano T. Choledochoduodenostomy: Simple side-to-side anas-tomosis. J Hepatobiliary Pancreat Surg 2000; 7(5): 486‒8.
Neoptolemos JP, Radley S.. Long-term results of choledocho-duodenostomy. HPB Surgery 1992; 5(2): 157‒9.
Malik AA, Rather SA, Bari SU, Wani AK. Long-term results of choledochoduodenostomy in benign biliary obstruc¬tion. World J Gastrointest Surg 2012; 4(2): 36‒40.
Madden JL, Chun JY, Kandalaft S, Parekh M. Choledocho-duodenostomy: an unjustly maligned surgical procedure? Am J Surg 1970; 119(1): 45‒54.
Sanders RL. Indications for and value of choledochoduo-denostomy. Ann Surg 1946; 123(5): 847‒58.
Ahrendt SA, Pitt HA. A history of the bilioenteric anastomo¬sis. Arch Surg 1990; 125(11): 1493‒500.
Abdelmajid K, Houssem H, Rafik G, Jarrar MS, Fehmi K. Open Choldecho-Enterostomy for Common Bile Duct Stones: Is it Out of Date in Laparo-Endoscopic Era? N Am J Med Sci 2013; 5(4): 288‒92.
Singh DP, Arora S. Evaluation of biliary enteric anastomo¬sis in benign biliary disordes. Indian J Surg 2014; 76(3): 199‒203.
Ducrotte P, Peillon C, Guillemot F, Testart J, Denis P. Could recurrent cholangitis after Roux-en-Y hepaticojejunostomy be explained by motor intestinal anomalies?, A manomet¬ric study. Am J Gastroenterol 1991; 86(9): 1255‒8.
Li SQ, Liang LJ, Peng BG, Lai JM, Lu MD, Li DM. Hepati-coje¬junostomy for hepatolithiasis: A critical ap¬praisal. World J Gastroenterol 2006; 12(26): 4170‒4.
Di Carlo I, Sauvanet A, Belgihiti J. Intrahepatic lithiasis: A Western expiriance. Surg Today 2000; 30(4): 319‒22.
Costamagna G, Boškoski I. Current treatment of benign bil¬iary strictures. Ann Gastroenterol 2013; 26(1): 37‒40.
Hirano S, Tanaka E, Tsuchikawa T, Matsumoto J, Shichinohe T, Ka-to K. Technique of buliary reconstruction following bile duct resection. J Hepatobiliary Pancreat Sci 2012; 19(3): 203‒9.
El Nakeeb A, Askr W, El Hanafy E, Atef E, Hamdy E, El He-maly M, et al. Long term outcomes of choledochoduo-denostomy for common bile duct stones in the era of laparos-copy and endoscopy. Hepatogastroenterology 2015; 62(137): 6‒10.
de Almeida AC, dos Santos NM, Aldeia FJ. Choledochoduo-denostomy in the management of common duct stones or as-sociated pathology: An obsolete method?. HPB Surg 1996; 10(1): 27‒33.
Leppard WM, Shary TM, Adams DB, Morgan KA, Choledo-choduodenostomy: Is it really so bad. J Gastrointest Surg 2011; 15(5): 754‒7.
Gupta BS. Choledochoduodenostomy: a study of 28 con-secutive cases. Kathmandu Univ Med J (KUMJ) 2004; 2(3): 193‒7.
Zeuge U, Fehr M, Meyenberger C, Sulz MC. Mind teh sump! ‒ diagnostic challenge of rare complication of choledocho-duodenostomy. Case Rep Gastroenterol 2014; 8(3): 358‒63.
Parks RW, Johnston GW, Rowlands BJ. Surgical billiary by¬pass for benign and malignant extrahepatic billiary tract disease. Br J Surg 1997; 84(4): 488‒92.
Tocchi A, Mazzoni G, Liotta G, Lepre L, Cassini D, Miccini M. Late Development of bile duct cancer in patinets who had bi-liary-enteric drainage for benign disease: A follow-up study of more than 1, 000 patients. Ann Surg 2001; 234(2): 210‒4.
Kuran S, Parlak E, Aydog G, Kacar S, Sasmaz N, Ozden A, et al. Bile reflux index after therapeutic biliary procedures. BMC Gastroenterol 2008; 8: 4.
Khalid K, Shafi M, Dar HM, Durrani KM. Choledochoduo-denostomy: Reappraisal in the laparoscopic era. ANZ J Surg 2008; 78(6): 495‒500.
Stein HJ, Smyrk TC, DeMeester TR, Rouse J, Hinder RA. Clinical value of endoscopy and the histology in the diag¬nosis of duodenogastric reflux disease. Surgery 1992; 112(4): 796‒804.
Sobala GM, O'Connor HJ, Dewar EP, King RF, Axon AT, Dixon MF. Bile reflux and intestinal metaplasia in gastric mucosa. J Clin Pathol 1993; 46(3): 235‒40.
Clavien PA, Barkun J, de Oliviera ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: Five-year experience. Ann Surg 2009; 250(2): 187‒96.
Lasnier C, Kohneh-Shahri N, Paineau J. Biliary-enteric anas-tomosis malfunction: retrospective study of 20 surgical cases. Review of literature. Ann Chir 2005; 130(9): 566‒72. (French)