Consideraţii privind conduita medico-chirurgicală postoperatorie în stricturile iatrogene biliare

Abstract

Scopul studiului este cercetarea conduitei medico-chirurgicale a pacienţilor, ce au suportat reconstrucţii la arborele biliar pentru stricturi iatrogene. Materiale şi metode: Pe parcursul ultimilor 20 de ani în Clinica 2 Chirurgie au fost trataţi 228 pacienţi cu stricturi bilare ale căilor biliare extrahepatice. Evaluarea clinică postoperatorie includea: 1). latura psiho-afectivă; 2). latura socială; 3). starea funcţională a sistemului hepato-biliar, apreciată pe baza testelor de laborator, examinărilor imagistice şi a testelor SF-36. Evaluarea rezultatelor la distanţă a fost posibilă pe un lot de 174 (76,3%) de pacienţi. Rezultate: Rezultat bun a fost fixat la 133 (76,4%) pacienţi cu reabilitare completă. Un rezultat satisfăcător am stabilit la 29 (16,67%) pacienţi, unde s-a marcat persistenţa durerilor periodice – 22 (13,58%) cazuri, semnelor dispeptice – 18 (11,11%) cazuri. La 12 (6,9%) pacienţi am remarcat rezultate nesatisfăcătoare. În 4 cazuri – icter mecanic motivat de calcul al firului de sutură a liniei de anastomoză. S-a rezolvat prin hepaticolitotomie. Icter mecanic, motivat de strictura gurii de anastomoză – prezent la 7 pacienţi. S-a efectuat enterotomie cu plastia gurii de anastomoză. A fost prezent un caz de reflux entero-biliar cu evaluarea colangitei de reflux, motivat de ansa jejunală sub 50 cm. S-a reconstruit în ansă cu braţul de 80 cm. Evoluţia clinică în toate cazurile a fost satisfăcătoare. Concluzii: Ajustarea conduitei medico-chirurgicale a asigurat lichidarea efectivă şi calitativă a complicaţiilor survenite şi a confirmat obiectiv calitatea vieţii la distanţă.

The aim of the study is the analysis of medico-surgical behavior of the patients that undergone reconstructions of the biliary tree for iatrogenic strictures. Materials and methods: There were treated 228 patients with biliary strictures of extrahepatic bile ducts during last 20 years in Surgical Clinic 2. Post-operative evaluation included: 1). psycho-affective side; 2). social side; 3). functional state of hepatobiliary system, appreciated based on laboratory tests, imagistic examinations and SF-36 tests. The assessment of results at distance was possible on a lot of 174 (76.3%) patients. Results: Good result was set on 133 (76.4%) patients with complete rehabilitation. A satisfactory result was established at 29 (16.67%) patients, at which persistence of periodic pain was remarked – 22 (13.58%) cases, dyspeptic signs – 18 (11.11%) cases. At 12 (6.9%) patients, we observed unsatisfactory results. In 4 cases debuted mechanical jaundice caused by calculus of suture thread of anastomotic line. We resorted to revision of anastomosis with hepatocholitotomia. Another 7 patients presented the picture of transitory mechanical jaundice reasoned by the stricture of anastomosis mouth. We conducted plasty of anastomosis with loop excluded in Y a la Roux. A case with entero-biliary reflux was present assessing a reflux cholangitis, motivated by the jejunal loop under 50 cm. Reconstruction in loop with an arm of 80 cm was performed. The clinical evolution in all cases was satisfactory. Conclusions: The adjustment of postoperative behaviour ensured the effective and qualitative liquidation of emerged complications and confirms objectively the quality of further life.