The comparative analysis of quality of life in patients operated for complicated choledocholithiasis

Abstract

Introduction: At the present stage of development of biliary surgery, altogether with traditional (laparotomie) methods, there exist MINIMA invasive methods of biliary decompression, but aspects of the final choice of strategy and tactics of the optimal treatment of these patients still remains relevant and disputable nowadays. Aim: The improvement of the remote results of complex surgical treatment of patients with complicated form of choledocholithiasis, on the basis of indicators of quality of life. Materials and Methods: The medical examination of quality of life in 120 patients, who were operated during the 2007 - 2010 for complicated choledocholithiasis. According the method of the operation the patients were divided into 2 groups: • 60 patients, who were treated with external drainage of biliary ducts, • 60 patients, who were treated by means of methods of the internal drainage. The assessment of quality of life was held by the general questionnaire SF-36 of the patients on the seventh day after the operation and in a year’s period. Results: The first group, the seventh day after the surgery:• the transcutaneous transhepatic cholangiostomy (TTCHS) • the laparotomic choledochotomy with the external drainage of the common bile duct (EDCH) • laparoscopic choledochostomy (LSCHS) The second group, the seventh day after the surgery: • the endoscopic papillosphincterotomy (EPST) • the stenting • the blending of choledochoainoaistomosis (CHAIA) and choledochoduodenoastamosis (CHDA) The first group, a year after the surgery: • TTCHS • LSCHS. • EDCH The second group, a year after the surgery: • the stenting of the choledoch • CHAIA • EPST •CHDA. Conclusions: 1. Each of the methods of the biliary decompression has clear indications and contraindications, the final choice of the method of the surgery, we believe, should be based primarily on the assessment of its impact on the quality of life in patients with the choledocholithiasis in the postoperative period with the primary usage of the sphincter-preserving invasions. 2. Using the methods of the external biliary decompression the indicators of quality of life of the patients after the sphincter miniinvasive procedures such as the transcutaneous cholangiostomy and laparoscopic transhepatic choledochostomy, reached to 97,4 ±2,1% and 85,3 ± 2,8% (related to the healthy people). 3. Among the methods of the internal biliary decompression, the highest results reached the stenting - 94,0 ± 3,7% (related to the healthy people). 4. Despite the fact that at the present stage of development of the biliary surgery the choledochoduodenoastamosis is widely used because of its simple technique and physiology, we recommend to use the choledochoainoaistomosis, after the application of which the indicators of quality of life of the patients are higher.