METHOD FOR SURGICAL TREATMENT OF INFLAMMATORY DISEASES OF BILE DUCTS

摘要

The method for the surgical treatment of the inflammatory diseases of the bile ducts comprises the laparotomy or the laparoscopy, the choledoch separation, the choledochotomy, the intraoperative fibrocholangioscopy, the sewing of the choledoch, and the postoperative management. The state of the mucosa of the bile duct is assessed performing the intraoperative fibrocholangioscopy. When the circular folding of the choledoch mucosa remains intact all through the duct or segmentally with the slight hemorrhage with the mucus readily washed-out, the mild inflammation is suggested. When the circular folding is absent, the small fibrin-covered erosions are detected on the background of the bulky hemorrhage with the mucus firmly attached to the mucosa the inflammation of the moderate degree is suggested. The massive erosions with fibrin and ichor, and the complete disappearance of the circular folding point to the severe inflammation. In the case of the mild inflammation, the choledoch is sewed completely and one antibiotic is used postoperatively. In the case of the moderate degree of inflammation, the choledoch is sewed and the external drainage is installed, again one antibiotic is used postoperatively. In the case of the severe inflammation, choledoch is sewed completely and postoperatively the intensive antibiotic therapy is initiated with two or three antibiotics.