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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">hepato</journal-id><journal-title-group><journal-title xml:lang="ru">Анналы хирургической гепатологии</journal-title><trans-title-group xml:lang="en"><trans-title>Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1995-5464</issn><issn pub-type="epub">2408-9524</issn><publisher><publisher-name>НЭИКОН ИСП</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.16931/1995-5464.2019248-59</article-id><article-id custom-type="elpub" pub-id-type="custom">hepato-510</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>МИНИИНВАЗИВНЫЕ ТЕХНОЛОГИИ ПРИ МЕХАНИЧЕСКОЙ ЖЕЛТУХЕ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>MINIMALLY INVASIVE TECHNOLOGIES FOR OBSTRUCTIVE JAUNDICE</subject></subj-group></article-categories><title-group><article-title>Антеградные рентгенхирургические вмешательства после безуспешного эндоскопического пособия при холедохолитиазе</article-title><trans-title-group xml:lang="en"><trans-title>Antegrade X-ray surgical interventions in patients with choledocholithiasis in case of failed endoscopic procedures</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6685-3183</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Охотников</surname><given-names>О. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Okhotnikov</surname><given-names>O. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Охотников Олег Иванович – доктор мед. наук, профессор, заведующий отделением рентгенохирургических методов диагностики и лечения №2 БМУ “Курская областная клиническая больница”, профессор кафедры лучевой диагностики и терапии ФГБОУ ВО КГМУ</p><p>305007, г. Курск, ул. Сумская, д. 45a</p><p>305041, г. Курск, ул. К. Маркса, д. 3 </p></bio><bio xml:lang="en"><p>Oleg I. Okhotnikov – Doct. of Sci. (Med.), Professor, Head of the X-ray Surgical Department №2, Kursk Regional Clinical Hospital, Professor of the Chair of Medical Radiology of Kursk State Medical University </p><p>45a, Sumskaya str., Kursk, 305007</p><p>3, K. Marks str., Kursk, 305041 </p></bio><email xlink:type="simple">oleg_okhotnikov@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3452-6652</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Яковлева</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Yakovleva</surname><given-names>M. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Яковлева Марина Валерьевна – канд. мед. наук, доцент, доцент кафедры хирургических болезней ФПО ФГБОУ ВО КГМУ, врач отделения рентгенохирургических методов диагностики и лечения №2 БМУ “Курская областная клиническая больница”</p><p>305007, г. Курск, ул. Сумская, д. 45a </p><p>305041, г. Курск, ул. К. Маркса, д. 3 </p></bio><bio xml:lang="en"><p>Marina V. Yakovleva – Cand. of Sci. (Med.), Associate Professor of the Chair of Surgical Diseases of Faculty of Post-qualifying Education, Kursk State Medical University; Surgeon of the X-ray Surgical Department №2, Kursk Regional Clinical Hospital.</p><p>45a, Sumskaya str., Kursk, 305007</p><p>3, K. Marks str., Kursk, 305041 </p></bio><email xlink:type="simple">marina_yakovleva_71@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6741-3358</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Григорьев</surname><given-names>С. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Grigoriev</surname><given-names>S. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Григорьев Сергей Николаевич – канд. мед. наук, заведующий отделением гнойной хирургии, врач отделения рентгенохирургических методов диагностики и лечения №2 БМУ “Курская областная клиническая больница”</p><p>305007, г. Курск, ул. Сумская, д. 45a </p></bio><bio xml:lang="en"><p>Sergey N. Grigoriev – Cand. of Sci. (Med.), Head of the Department of Suppurative Surgery, Surgeon of the X-ray Surgical Department №2, Kursk Regional Clinical Hospital</p><p>45a, Sumskaya str., Kursk, 305007 </p></bio><email xlink:type="simple">sng-kursk@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8421-430X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Пахомов</surname><given-names>В. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Pakhomov</surname><given-names>V. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Пахомов Вадим Игоревич – врач отделения рентгенохирургических методов диагностики и лечения №2 БМУ “Курская областная клиническая больница”</p><p>305007, г. Курск, ул. Сумская, д. 45a </p></bio><bio xml:lang="en"><p>Vadim I. Pakhomov – Surgeon of the X-ray Surgical Department №2, Kursk Regional Clinical Hospital </p><p>45a, Sumskaya str., Kursk, 305007 </p></bio><email xlink:type="simple">vpnetmail@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3576-3185</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шевченко</surname><given-names>Н. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Shevchenko</surname><given-names>N. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шевченко Николай Иванович – канд. мед. наук, врач отделения рентгенохирургических методов диагностики и лечения №2 БМУ “Курская областная клиническая больница</p><p>305007, г. Курск, ул. Сумская, д. 45a </p></bio><bio xml:lang="en"><p>Nikolai I. Shevchenko – Cand. of Sci. (Med.), Surgeon of the X-ray Surgical Department №2, Kursk Regional Clinical Hospital </p><p>45a, Sumskaya str., Kursk, 305007 </p></bio><email xlink:type="simple">nickolya@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3628-2188</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Охотников</surname><given-names>О. О.</given-names></name><name name-style="western" xml:lang="en"><surname>Okhotnikov</surname><given-names>O. O.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Охотников Олег Олегович – студент лечебного факультета ФГБОУ ВО КГМУ </p><p>305041, г. Курск, ул. К. Маркса, д. 3</p><p>Тел.: 8-910-740-20-92 </p></bio><bio xml:lang="en"><p>Oleg O. Okhotnikov – Student of Medical Faculty of the Kursk State Medical University </p><p>3, K. Marks str., Kursk, 305041</p><p>Phone: +7-910-740-20-92 </p></bio><email xlink:type="simple">okhotnikov_99_99@mail.ru</email><xref ref-type="aff" rid="aff-4"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>БМУ “Курская областная клиническая больница”, отделение рентгенохирургических методов диагностики и лечения №2; Кафедра лучевой диагностики и терапии ФГБОУ ВО “Курский государственный медицинский университет” Министерства здравоохранения России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kursk Regional Clinical Hospital, X-ray Surgical Department; Chair of Medical Radiology of the Kursk State Medical University of Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>БМУ “Курская областная клиническая больница”, отделение рентгенохирургических методов диагностики и лечения №2; Кафедра хирургических болезней ФПО ФГБОУ ВО “Курский государственный медицинский университет” Министерства здравоохранения России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kursk Regional Clinical Hospital, X-ray Surgical Department; Chair of Surgical Diseases of Faculty of Post-qualifying Education of the Kursk State Medical University of Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>БМУ “Курская областная клиническая больница”, отделение рентгенохирургических методов диагностики и лечения №2</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kursk Regional Clinical Hospital, X-ray Surgical Department</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Лечебный факультет ФГБОУ ВО “Курский государственный медицинский университет” Министерства здравоохранения России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Medical Faculty of the Kursk State Medical University of Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2019</year></pub-date><pub-date pub-type="epub"><day>21</day><month>06</month><year>2019</year></pub-date><volume>24</volume><issue>2</issue><fpage>48</fpage><lpage>59</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Охотников О.И., Яковлева М.В., Григорьев С.Н., Пахомов В.И., Шевченко Н.И., Охотников О.О., 2019</copyright-statement><copyright-year>2019</copyright-year><copyright-holder xml:lang="ru">Охотников О.И., Яковлева М.В., Григорьев С.Н., Пахомов В.И., Шевченко Н.И., Охотников О.О.</copyright-holder><copyright-holder xml:lang="en">Okhotnikov O.I., Yakovleva M.V., Grigoriev S.N., Pakhomov V.I., Shevchenko N.I., Okhotnikov O.O.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://hepato.elpub.ru/jour/article/view/510">https://hepato.elpub.ru/jour/article/view/510</self-uri><abstract><p>Цель. Определить безопасность и эффективность рентгенхирургического устранения холедохолитиаза после безуспешного эндоскопического пособия. Материал и методы. Ретроспективному анализу подвергнуты результаты рентгенхирургического разрешения холедохолитиаза у 195 пациентов. Первичным вмешательством была антеградная холангиостомия. Выбор эндобилиарного вмешательства осуществляли по результатам холангиографии. Методы устранения холедохолитиаза включали антеградную механическую и пневматическую холедохолитотрипсию и литэкстракцию, баллонную дислокацию конкрементов общего желчного протока в двенадцатиперстную или тощую кишку, литэкстракцию методом “рандеву” после эндоскопической папиллотомии по транспапиллярному дренажу или проводнику. Результаты. Пункция и дренирование нерасширенных желчных протоков выполнены 30 (15,4%) пациентам. Всего выполнили 212 холангиостомий у 195 пациентов с учетом повторных вмешательств. Без осложнений холангиостомия выполнена в 92,9% наблюдений. Общее число “малых” осложнений составило 7,1%. Антеградная механическая и пневматическая литотрипсия и литэкстракция выполнена 118 (98,3%) пациентам. Дислокация конкрементов общего желчного протока в двенадцатиперстную кишку баллоном применена 52 (81,3%) больным. Литэкстракцию методом “рандеву” после эндоскопической сфинктеротомии провели 12 (60%) пациентам. В 6 наблюдениях выполнили транспапиллярное наружновнутреннее дренирование общего желчного протока в обход конкремента. В 5 наблюдениях холангиолитиаза, осложнившего стриктуру билио дигестивного анастомоза, выполнили низведение конкрементов в тощую кишку после баллонной дилатации стриктуры либо антеградную литотрипсию и литэкстракцию. Послеоперационная летальность составила 1,5%. Полной ликвидации холангиолитиаза с помощью миниинвазивных методов удалось добиться у 187 (98,9%) пациентов. Заключение. Антеградные рентгенхирургические методы представляются эффективными и безопасными лечебными вмешательствами у пациентов, перенесших безуспешные эндоскопические попытки устранения холангиолитиаза. Интегральная эффективность методов антеградного разрешения холангиолитиаза составила 88,8%.</p></abstract><trans-abstract xml:lang="en"><p>Objective. To analyze safety and efficacy of X-ray surgical treatment of choledocholithiasis in case of failed endoscopic procedures. Material and methods. A retrospective analysis included 195 patients with choledocholithiasis who underwent X-ray surgical treatment. Primary X-ray surgical intervention was antegrade cholangiostomy. Data of antegrade cholangiography were used to determine type of endobiliary intervention. Antegrade mechanical and pneumatic choledocholithotripsy and lithoextraction, balloon dislocation of stones of the common bile duct into duodenum or jejunum, lithoextraction using rendezvous technique after endoscopic papillotomy through transpapillary drainage tube or a wire were applied. Results. Puncture and drainage of non-dilated bile ducts were successfully performed in 30 (15.4%) patients. There were 212 procedires of cholangiostomy in 195 patients including redo interventions. Complications after cholangiostomy were absent in 92.9% of cases. Minor complications occurred in 7.1% of cases. Antegrade mechanical and pneumatic choledocholithotripsy and lithoextraction was performed in 118 (98.3%) patients. Balloon dislocation of stones of the common bile duct into duodenum was applied in 52 (81.3%) patients. Lithoextraction using rendezvous technique after previous endoscopic papillosphincterotomy was performed in 12 (60%) patients. Six patients underwent transpapillary external-internal drainage of common bile duct. Five patients had stricture of biliodigestive anastomosis complicated by cholelithiasis. Lithotripsy and lithoextraction through antegrade approach or dislocation of stones into jejunum after previous balloon dilatation were performed in these patients. Postoperative mortality was 1.5%. Minimally invasive techniques were absolutely effective for choledocholithiasis in 187 (98.9%) patients. Conclusion. Antegrade X-ray surgical management is effective and safe in patients with choledocholithiasis and unsuccessful previous endoscopic procedures. Integral efficiency of antegrade management of cholelithiasis was 88.8%.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>желчные протоки</kwd><kwd>холангиолитиаз</kwd><kwd>холедохолитиаз</kwd><kwd>механическая желтуха</kwd><kwd>холангиостомия</kwd><kwd>баллонная дилатация</kwd><kwd>литотрипсия</kwd><kwd>литэкстракция</kwd><kwd>“рандеву”</kwd></kwd-group><kwd-group xml:lang="en"><kwd>bile ducts</kwd><kwd>cholangiolithiasis</kwd><kwd>choledocholithiasis</kwd><kwd>obstructive jaundice</kwd><kwd>cholangiostomy</kwd><kwd>balloon dilatation</kwd><kwd>lithotripsy</kwd><kwd>lithoextraction</kwd><kwd>“rendezvous” technique</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Руководство по хирургии желчных путей. Под ред. Гальперина Э.И., Ветшева П.С. 2-е изд. 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