A method of treatment of cholangitis with mechanical jaundice

 

The invention relates to medicine, namely to surgery, and can be used for the treatment of cholangitis with mechanical jaundice. Provide endoscopic papillosphincterotomy and lithoextraction. Intraoperative washed choledoch ozonated of 0.9% sodium chloride solution with a concentration of 1,100-1,200 mg/L. subsequently carry out reorganization of the choledochus ozonated of 0.9% sodium chloride solution with a concentration of 800-850 mg/l during endoscopic fibrogastroduodenoscopy daily for 3-5 days. Then washed choledoch ozonated of 0.9% sodium chloride solution with a concentration of 550-600 mg/l after draining it Hosted-Pikovsky during laparoscopic cholecystectomy. The method improves the efficiency of the treatment and reduces the time of treatment. table 1.

The invention relates to medicine, in particular to surgery.

There is a method of treatment of cholangitis with mechanical jaundice calculous etiology by endoscopic papillosphincterotomy apst) removing concretions from the choledochus with antibiotic and fluid therapy. In what is a laparoscopic cholecystectomy to prevent receive the treatment is not effective enough, accompanied by mortality to 12.3% [Rodionov centuries Calculous cholecystitis (complicated by mechanical jaundice). - M.: Medicine, 1991, 275-290 S.], large duration edema effects of obstructive jaundice, hepatic dysfunction, cholangitis, which is reflected in the terms of stay of the patient in the hospital.

The technical result is to reduce mortality, reduce the time of preparation for the required operations, the reduction of treatment time and patient stay in the hospital.

The technical result is achieved by the fact that the patient is additionally carried out after EPST and lilienstrasse intraoperative lavage choledochus ozonated of 0.9% sodium chloride solution with a concentration of 1,100-1,200 g/l, with subsequent readjustment of the choledochus ozonated of 0.9% sodium chloride solution with a concentration of 800-850 mg/l during endoscopic fibrogastroduodenoscopy (FGDS) daily for 3-5 days, then washing the choledochus ozonated of 0.9% sodium chloride solution with a concentration of 550-600 g/l is carried out after the drainage him on the Halstead-Pikovsky during laparoscopic cholecystectomy, as well as daily intravenous infusion Osherov and the severity of the manifestations of the syndrome of endogenous intoxication, hepatic dysfunction and clinical and laboratory symptoms of cholangitis.

Example.

Patient P., 52, with a diagnosis of JCB, chronic calculous cholecystitis, choledocholithiasis, cholangitis, obstructive jaundice.

The patient produced retrograde retrograde cholangiopancreatography with endoscopic papillosphincterotomy, lithoextraction, supplemented by intraoperative lavage choledochus ozonated of 0.9% sodium chloride solution with a concentration of 1,100-1,200 mg/L. medication: Cefazolin 1.0 g 2 times a day/m, metrogylum 100 ml 2 times a day/, gemodez 400 ml/1 time per day, polarizing mixture: 5% glucose - 400 ml, insulin 6 UNITS, KCl 4% to 20 ml, MgSO425% - 5 ml/2 times a day, vitamin B1In6/m by day and ascorbic acid - in/century Advanced medical complex was included washing the choledochus ozonated of 0.9% sodium chloride solution with a concentration of 800-850 mg/l during FGDS daily for 4 days.

After 5 days of intensive care were strong positive trend in the condition of the patient. The patient returned to normal body temperature, pulse 80 beats per minute, BP 120/80 mm RT.art., significantly reduced the severity of Piceno reflected in the table. On the seventh day of inpatient treatment the patient produced laparoscopic cholecystectomy with drainage choledochus by Halstead-Pikovsky. The postoperative period was uneventful, drainage 30-50 ml of bile per day. To prevent cholangitis drainage were washed in ozonated of 0.9% sodium chloride solution with a concentration of 550-600 g/L. In General, the patient's condition progressively improved. Over the entire course of treatment the patient made a lavage of choledochus ozonated (with a concentration of 1,100-1,200 g/l) in 0.9% sodium chloride solution intraoperatively after EPST, lilienstrasse and when conducting daily FGDS (with a concentration of 800-850 g/l) for 4 days, in the subsequent prevention of cholangitis after laparoscopic cholecystectomy with drainage choledochus by Halstead-Pikovsky the patient made a lavage of choledochus ozonated (with a concentration of 550-600 g/l) in 0.9% sodium chloride solution. In addition, patients were 8 infusions of ozonized solution of 0.9% sodium chloride in a volume of 450 ml with a concentration of 400-450 mg/l daily intravenous 1 time per day. With the introduction of ozonized solution of 0.9% sodium chloride pathological side reactions, the patient is not amechtley a method of treatment of cholangitis with mechanical jaundice calculous etiology reduced the incidence of mortality, the period of hospitalization by 25% on average, the preparation time to conduct the necessary operations. Quick relief of symptoms of endotoxemia, hepatic dysfunction and cholangitis is characterized by the normalization of the indicators bilirubinuria, fermentee, molecules of average weight, the activation of the antioxidative system, lower level of products of lipid peroxidation, which confirms the effectiveness of treatment.

Claims

A method of treatment of cholangitis with mechanical jaundice calculous etiology by endoscopic papillosphincterotomy, lilienstrasse in combination with intensive medical therapy and subsequent laparoscopic cholecystectomy, wherein the patient is additionally carried out a complex of measures for effective sanitization of the choledochus, carried out in three stages, intraoperative lavage choledochus ozonized solution of 0.9% sodium chloride with a concentration of 1,100-1,200 g/l after endoscopic papillosphincterotomy and lilienstrasse, washing choledochus ozonized solution of 0.9% sodium chloride with a concentration of 800-850 mg/l during endoscopic fibrogastroduodenoscopy daily for 3-5 komicheskoi cholecystectomy with drainage him on the Halstead-Pikovsky.

 

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