Extracorporeal lithotripsy
Noninvasive method of crushing konkrementov gall bladder went into medical practice in 1985, the emergence of this method led to the doctors hope to the possibility of its widespread use that would allow many patients to avoid surgery. However, early observations showed that not every patient can recommend this treatment and not in all cases achieved positive results. To obtain the therapeutic effect required a rigorous selection of patients. Experience shows that the effectiveness of extracorporeal lithotripsy (EKLT) depends on the properties of concretions in the success of their fragmentation and elimination, as well as the functional state of the gallbladder, which determines the frequency of complications and side effects of the elimination period and early recurrence of stone formation.
The selection criteria for patients with brand viagra cholecystolithiasis (symptomatic and asymptomatic forms of the disease) for EKLT are: single and few (2-4) concretions, which occupy less than 1 / 2 volume of the gallbladder, the preservation of contractile-evacuation function of the gallbladder. Treatment success depends largely on the presence of concrements calcium salts and their degree of calcification. Good treatment results are achieved in patients with ehopronitsaemymi and ehoneplotnymi (not containing calcium salts), radiolucent concrements, an increase in their ehonepronitsaemosti and ehoplotnosti signs of radiopacity efficiency of crushing falls.
Contraindications EKLT are: multiple cholecystolithiasis, which occupies more than 1 / 2 volume of the gallbladder, calcified stones, decrease contractility-evacuation function of the gallbladder, and disabled gallbladder; concretions of bile ducts and biliary obstruction, the impossibility of enteral litolizisa after crushing concretions (gastroduodenal ulcer , allergy), pregnancy.
About rezultath lithotripsy judged by 3-18 months, when there is a release from the gall bladder stone fragments. To expedite the process of elimination and reduction of the size of fragments of patients prescribed oral litoliticheskuyu therapy. In the short and long periods of process of elimination of the fragments can produce complications in the form of attacks of biliary colic, acute cholecystitis, obstructive jaundice and acute pancreatitis. It should be noted that these complications are rare. With strict selection of patients with good outcomes (full exemption from the gall bladder concretions) occurs in 65-70% of patients. Unsatisfactory results EKLT when fragments do not come out of the gallbladder or, alternatively, increase in size, associated with either incorrect estimation of the function of the gallbladder or from the qualitative composition of the stones. After successful lithotripsy possible recurrence of stone formation, were observed in 20-23% of patients who underwent this procedure (most of them have lipid metabolism). Measure to prevent the recurrence of the disease in such patients is to conduct a corrective holesterinsnizhayuschey therapy.
Non-operational methods of treatment inherent in one drawback nepatogenetichnost therapy. Expect good outcomes when applied in the late period is not necessary, because if you can not work on all the links in the pathogenesis of the disease remains the gallbladder body, forming concretions. That is why surgical removal of the gall bladder is seen as a radical method of treatment of gallstone disease, relieving the patient of biliary colic and dangerous complications. Currently, hospitals use three ways to remove the gallbladder: laparoscopic, surgery of the minimal surgical approach and the standard laparotomy.
Laparoscopic cholecystectomy
Appearance in the medical practice of the method of laparoscopic cholecystectomy (LCE) was a new landmark in the development of surgery of cholelithiasis. For a little more than 10-year existence it has won wide recognition and has been further improved. Endoscopic method began to produce 70-80% of cholecystectomy.
By the indications for LCE include symptomatic uncomplicated gallstone disease, asymptomatic form of the disease and cholesterosis gallbladder. Improved technology in endoscopic surgery has allowed to expand indications for intervention in combined lesions of the bile ducts. Among the contraindications for this operation produce a dense inflammatory infiltrate in the Viagra an epidemic neck of the gallbladder and gepatoduodenalnoy ligament, pregnancy, deferred laparotomy, obesity, liver cirrhosis, intrahepatic location of the gallbladder, obstructive jaundice and acute pancreatitis. Some authors consider these contraindications, except for the first two, relative and at the same time stressed that the operation's success is largely determined by the level of training of surgeon and technical equipment of the operating room. However, these contraindications can not be underestimated, since in these situations there is a risk of intraoperative complications and, moreover, there is a need for conversion (transition to a laparotomy), which extends the operation time by 2-3 times.
LCE operation is usually carried out under general anesthesia, while ensuring that the deep relaxation of the abdominal wall. The main steps of endoscopic surgery are: the creation of pneumoperitoneum, the introduction of trocars and instruments, inspection of the abdominal cavity, the selection of the gall bladder adhesions, cystic duct and cystic artery with subsequent clipping and intersection, the selection of the gallbladder from liver bed and removed from the abdominal cavity (sometimes with the use of container) and installation of the control of drainage in podpechenochnom space. For the introduction of trocars into the abdominal cavity produce arcuate incision length 1,5-2 cm above or below the navel and three cut length of 56 mm in the right upper quadrant.
Some patients
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