HOLETsISTOPANKREATYT (Greek chole bile + kystis bubble + pancreatitis; a synonym holetsistokholangio-pancreatitis) — a combination of pancreatitis to diseases of bilious ways.
By data I. G. Rufanova (1925), the most part of cases of pancreatitis (to 85%) etiologically is connected with a disease of bilious ways (cholecystitis, a cholelithiasis). It is explained with a pelting of the bile which is (especially infected) in pancreat ducts and development of bilious hypertensia, and also lim-fo-or hematogenous distribution of contagiums with damage of a pancreas. At blockade of terminal department of the general bilious channel (in connection with obstruction by a stone, as a result of a stenosis) bilious to - you have the destroying effect on tissue of a pancreas.
Clinically holetsistopankreatit it is shown by symptoms of both diseases with dominance of manifestations either cholecystitis (see), or pancreatitis (see) that creates a polymorphic picture of a disease of various weight. The most severe forms are observed during the involvement in patol. process of the general hepatic and the general bilious channels (see the Cholangitis), especially at development of jaundice.
Diagnosis holetsistopankreati-that is based on clinical laboratory. radiological and Wad Dra - it is silent the methods of a research applied to recognition of these diseases. Also complex intraoperative research of bilious ways is important (see. Bilious channels, methods of a research).
At inefficiency of conservative therapy (see Pancreatitis, Cholecystitis) apply operational treatment. When inflammatory process is limited to a gall bladder and pancreatitis proceeds benign, removal of a gall bladder (see the Cholecystectomia) leads to recovery of patients. At more severe forms of damage of a pancreas after a cholecystectomia also there occurs considerable improvement, however in the subsequent observance of a rigid diet is necessary and, at indications, conservative treatment. At defeat of extrahepatic bilious channels (existence of concrements, a stricture, etc.) the disease proceeds much heavier and demands more difficult surgeries directed to removal of bile. The choice of adequate operation in similar cases depends on character arisen patol. changes. At a choledocholithiasis, a cholangitis, considerable expansion of bilious channels without the expressed disturbance of their passability make a choledochostomy (see). At a prelum of a bilious channel the increased head of a pancreas ratsionny jaundice develops to an obt, a cut it is necessary to make internal drainage of a channel for elimination — a choledochoenterostomy or choledochoduodenostomy (see). At the isolated blockade of a faterov of a nipple (as a result of obstruction the stone, strictures) showed a papillosfinkterotomiya (see Faterov of pacifiers). At blockade in the field of the general bilious channel and a faterov of a nipple the combined operation is necessary: choledochoduodenostomy and papillosfinkterotomiya.
The forecast at timely recognition and correctly carried out treatment favorable. In the subsequent dispensary observation by the surgeon and the gastroenterologist, and also prolonged conservative treatment is required.
Bibliography: Vinogradov V. V., etc. Surgery of pancreatitis, Tashkent, 1974, bibliogr.; L both d with to and y A. T. Surgical diseases of a liver and bile-excreting system, M., 1963; Niderleb., etc. Surgery of bilious ways, the lane from Czeches., Prague, 1982; Rufanov. G. Pancreatitis in connection with inflammatory process of bilious ways and a bubble, M., 1925; Savelyev B.C.,
Buyanov V. M. and Ognevyu. B. Acute pancreatitis, M., 1983; Smirnova. Century, On
re m with to and y O. B. and Fridd. I. Surgical treatment of diseases of a pancreas and periampulyarny area, L., 1972; F and l and V. I N. Acute diseases and injuries of a pancreas, L., 1982, bibliogr.; Since with u t-zfel d t W. SchmidtH. Aethiology and pathogenesis of pancreatitis, Scand.
J. Gastroent., v. 5, suppl. 6, p. 47, 1970; H e s s W. Die Erkrankungen der Gallen-wege und des Pankreas, Stuttgart, 1961; La taste J.etDocquierJ. Lithiase biliaire et pancr^atite chronique, Presse m6d., t. 70, p. 2413, 1962; S t and r t M. H o e r r S. O. Late results of side to side choledochoduodenostomy and of transduo-denal sphincterotomy for benign disorders, Amer. J. Surg., v. 123, p. 67, 1972.
O. B. Milonov.