METHOD FOR SURGICAL TREATMENT OF ACUTE DESTRUCTIVE CHOLECYSTITIS WITH LOCAL PERITONITIS IN PATIENTS WITH SEVERE OVERALL CONDITION

摘要

A method for the surgical treatment of the acute destructive cholecystitis with local peritonitis in the patients with severe overall condition comprises cholecystostoma applied through transcutaneous-transhepatic draining of the gall bladder under the ultrasonic control with the aid of stylette-catheter system of "pig tail" type with decompression and sanitization of the gall bladder. The revision, sanitization, and draining of subhepatic space is performed with the aid of polyvinyl chloride tubular and semi-glove rubber drainages from minilaparotomic access in the right subcostal area. Mini-assistant set with video laparoscopic appliance is used. The cavity of gall bladder is sanitized periodically with antiseptic solution for 4-5 days. On the 4-5th day, X-ray contrast cholecystofistulography is performed. When the obstruction of cystic duct is confirmed, sclerosant is administered into the cavity of the gall bladder without prior concrement removal following the treatment of the mucosa of the gall bladder with 0.5 % solution of Novocain. 96 % ethanol is administered five times with 30 s exposure.