Tulžies latakų anastomozės ir jų komplikacijų gydymas: sisteminė literatūros apžvalga
vadas. Tulžies latakų anastomozės – esminė hepatobiliarinės chirurgijos dalis, užtikrinanti tulžies tekėjimą po kepenų ir tulžies latakų įvairių operacijų. Nepaisant svarbos, tulžies latakų anastomozės siejamos su reikšmingomis pooperacinėmis komplikacijomis, kurios gali turėti didelį poveikį pacientų išgyvenamumui. Straipsnio tikslas – išanalizuoti ir apibendrinti pastarojo dešimtmečio duomenis apie tulžies latakų anastomozes, jų komplikacijas ir gydymą. Metodai. Mokslinės literatūros paieška atlikta PubMed, Medline ir Scopus duomenų bazėse. Iš viso rasti 1 862 straipsniai, kuriuose nagrinėjami tulžies latakų anastomozių rezultatai. Taikant atrankos kriterijus, atrinkta 16 mokslinių straipsnių, kurie išanalizuoti išsamiau. Rezultatai. Sisteminė analizė apėmė 1 606 pacientus. Atvirosios operacijos sudarė 79,7 proc., o minimaliai invazinės procedūros – 20,3 proc. Iš chirurginių anastomozių dažniausiai taikyta choledochocholedochostomija (65,4 %). Dažniausia atvirų operacijų komplikacija – tulžies latakų striktūra (25,65 %). Iš 522 komplikacijų invazinis gydymas buvo reikalingas 357 atvejais (68,39 %). Komplikacijos dažniausiai buvo gydomos taikant endoskopinę retrogradinę cholangiopankreatografiją. Su komplikacijų gydymu susijusių komplikacijų dažnis siekė 16,81 proc., dažniausia iš jų buvo ūminis pankreatitas (3,08 %). Tarp minimaliai invazinių endoskopinių technikų dominavo endoskopinė ultragarsu kontroliuojama choledochoduodenostomija (84,26 %). Dažniausia šių metodų komplikacija – stento užsikimšimas (4,66 %). Dažniausiai naudotas spindžius suartinantis metalinis stentas (49,14 %). Išvados. Mokslinės literatūros apžvalga parodė, kad daugiausia taikomos atvirosios chirurginės technikos. Dažniausia technika – choledochocholedochostomija. Minimaliai invazinės operacijos tulžies takų ligoms gydyti taikomos rečiau, tačiau jos yra veiksminga alternatyva gydant tulžies takų komplikacijas. Pagrindinės alternatyvos – endoskopinės ultragarsu kontroliuojamos tulžies latakų drenavimo technikos. Dažniausia komplikacija – tulžies latakų striktūra. Komplikacijos daugiausia gydomos atliekant endoskopinę retrogradinę cholangiopankreatografiją.
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