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SM ISO690:2012 HOTINEANU, Vladimir, HURMUZACHE, Artur, HOTINEANU, Adrian, BORTĂ, Eduard. Patologia căii biliare principale in malrotaţia duodenală asociată cu duodenostază. In: Arta Medica , 2010, nr. 3(42), pp. 40-48. ISSN 1810-1852. |
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Arta Medica | ||||||
Numărul 3(42) / 2010 / ISSN 1810-1852 /ISSNe 1810-1879 | ||||||
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Pag. 40-48 | ||||||
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This article is dedicated to the problem of chronic duodenal obstruction – actual problem of diagnosis, treatment and main component of the pathology in biliopancreatoduodenal region. In a group of patients although the biliary flow was reestablished after endoscopic retrograde cholangiopancreatography, the biliary pathology persist manifested through the clinical picture of transitory mechanical jaundice, chronic cholangitis and choledocholytiasis. In 5-15% cases the biliary pathology reemerged due to the development of duodeno-biliary reflux, on the background
of duodenal malrotation (MrD) with duodenostasis and insufficiency of papilla Water. This research was carried out for period of 11 years (1998- 2009), including a number of 110 patients. All the patients underwent colecistectomy and afterwards reinterventions on biliary tract including endoscopic retrograde cholangiopancreatography (ErCP), endoscopic papillosfincterothomy (PSTE), and choledochoduodenoanastomosis (CDA) with choledocholitotomy (ClT). The diagnostic algorithm included: biochemical tests, USG, gastroduodenography with radiopharmaceutical
component, biliscintigraphy, electrogastroenterography (EGEG), TC-rMN, and ErCP. The paraclinical investigations demonstrated the presence of duodenostasis and duodenal malrotation, duodenobiliary reflux, CBD over 1,5 cm with primary stones, choledocholytiasis, cholangitis. Until 1998 the surgical treatment in 16 patients included biliodigestive anastomosis-choledochoduodenoanastomosis and choledochojejunoanastomosis (CDA, CJA).The results were unsatisfactory because more that 50% the clinical signs persisted , caused by the maintenance of the duodenobiliary reflux of MrD with duodenostasis , this considerations allowed us to propose in implement a new operational technique which excludes the duodenobiliary reflux, consisting in supraduodenal excision of CBD with its implantation in ,,Y” loop a la roux. This tactic of treatment allowed the recovery of the patients with minimal risk of postoperative complications and socio-professional reintegration. |
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