RU2277916C2 - Method for treating purulent cholangitis - Google Patents

Abstract

FIELD: medicine, abdominal surgery.

SUBSTANCE: one should drain biliary ducts and wash with 0.02%-sodium hypochlorite solution at the dosage of 150-200 ml, by drops, 3-4 times daily for 7-17 d. Moreover, also, during 7-17 d it is necessary to carry out infusion therapy through catheterized portal vein by applying conventional medicinal preparations and introduce 0.04%-sodium hypochlorite per 50-80 ml thrice daily. The innovation provides therapeutic efficiency at applying sodium hypochlorite in lower concentration against well known for sanitation of biliary tract that enables to decrease toxic effect of sodium hypochlorite during therapy conducted.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

Description

The invention relates to medicine, in particular to abdominal surgery, and is intended for the treatment of purulent-destructive processes in the hepatobiliary system.

The number of patients with purulent-destructive processes in the liver, bile ducts increases (Maystrenko N.A., 2000) and averages 34% in urgent surgery of the abdominal cavity organs. The most common cause is gallstone disease, complicated by destructive cholecystitis, purulent cholangitis, cholangiogenic abscesses, biliary sepsis.

Classical purulent surgery approaches oblige the surgeon, first, to sanitize the infection by removing the affected organ (cholecystectomy) and draining (external, internal or combined) of the duct system.

The second task in the treatment is to treat the purulent focus with antibacterial agents. Given the features of the liver as an organ, where there are 2 pools of inflow (the portal - from the digestive system and the arterial - vessels of the big circle), both routes are used for drug delivery.

The successful use of the umbilical vein for the correction of homeostasis in burn disease (Atyasov N.I. et al., 1993), in the treatment of pancreatitis, peritonitis, etc. is known. In this case, in addition to conventional treatment, a significant part of the infusion therapy is carried out through the portal pool.

There is a method of treating obstructive jaundice, which allows to increase the efficiency of biliary tract rehabilitation according to the copyright certificate No. 1729494 - the authors V.G. Ivshin, O.D.Lukichev (1986). In this method, under the supervision of an ultrasound, a percutaneous transhepatic cholangiostoma is applied. Initial bile pressure is measured. The end of the drainage is raised along the mid-axillary line to a height equal to the initial pressure. Furacilin is administered through the cholangiostoma until a transparent dialysate appears. Next, the washing is carried out in a dosage decompression mode.

At the same time, percutaneous transhepatic drainage is a rather traumatic measure. Its implementation is possible only with a significant expansion of the ducts (with prolonged jaundice). It is known that furatsilin as an antiseptic is not effective enough for the pyogenic nature of inflammation (Struchkov V.I. et al., 1991). It does not have a necro-fibrinolytic effect, which makes it difficult to clean the pathological focus. In addition, antimicrobial agents of the nitrofuran group can cause granulomatous hepatitis due to increased enzyme activity (Viktorov O.P. et al., 1996), and with the initial pathology of the liver, the risk of hepatotoxicity increases (Strachunsky L.S. et al., 2002).

A known method of treating liver failure according to copyright certificate No. 1120980, authors S.A. Shalimov, V.I. Zubkov, V.V. Skiba (1984), according to which the treatment of liver failure is carried out by blood sampling from the portal system, oxygenation and detoxification of it. The method is as follows: surgically extraperitoneally according to Ostroverkhov or via peritoneal access, transumbilical catheterization of the portal vein is performed using a double-lumen catheter with a diameter of 4-5 mm. The short channel of the catheter is installed at the mouth of the umbilical vein, and the long channel of the catheter is carried out 4-5 cm into the portal vein. Blood drawn through a shortened channel is pumped to a column with a sorbent using a roller pump, then to a 400 ml oxygenator, which works simultaneously with a temperature-controlled device, and is returned to the liver vein through a long channel.

Different length channels of a double-lumen catheter are used to prevent mixing of blood flows. The use of a small-capacity oxygenator and a temperature-regulating device allows for the thermal stabilization of perfusate during hemoperfusion while enriching venous blood with oxygen. Hemoperfusion is performed at a blood temperature of 37 ° C at a speed of 80-100 ml for 2-3 hours. Hemoperfusion is repeated several times. In the process of hemoperfusion, drugs used for intensive therapy of liver failure (glucose, vitamins, hemodez, reopoliglyukin, hormones, etc.) are introduced into the oxygenator. As equipment, known constructions of adsorption columns and perfusion devices can be used.

However, the analogue provides for the rehabilitation of only the portal basin, and the return of blood is carried out only in its left branch, excluding the effect on most of the liver parenchyma (6 out of 8 segments). It is also known that the pressure in the portal vein is low and does not exceed 7 mm Hg. Art., and with pathological processes, venous stasis, it can be even lower, which makes it difficult to take blood from the portal pool, especially in a continuous mode with a pump.

Blood purification through hemosorbent does not remove all toxic substances, the bactericidal effect is achieved by oxygenation, which is not enough for aerobic microorganisms. In addition, perfusion of blood through a sorbent leads to the destruction of shaped elements ("dusting of coal") (Reshetnikov EA et al., 2001). Thus, destroyed blood cells and sorbent particles entering the portal bloodstream can lead to microthrombosis (Reshetnikov E.A. et al., 2001).

As a prototype, a method of conducting intraductal sorption detoxification according to the author's certificate 1599022 of the USSR, MKI 5 A 61 M 1/00, V.P. Andryushchenko, D.A. Makar, in which an external drainage according to Robson-Vishnevsky with an inflatable cuff is installed in the bile duct, was taken , an air duct for inflation of which is placed inside the main tube and fixed to its wall. Through the lumen of the main drainage, a thin elastic probe is inserted as far as possible into the lobar duct, which, together with the outer tube, is brought out to the anterior abdominal wall. A predetermined volume of air is introduced through a duct using a syringe, which creates a sealed isolation of the common bile duct. A sorbent (suspension of Aerosil in a solution of furatsilina) is injected via a syringe through an internal catheter until the bile ducts are completely filled. After this, the main drainage is closed for 20-25 minutes, while the bile secreted by the liver flows out through the internal drainage. At the end of the sorption session, the drainage is opened and the sorbent is washed through it by introducing an antiseptic solution through an internal catheter.

The prototype implements the idea of active rehabilitation of the biliary tract, which, however, has some disadvantages. So, the introduction of such drainage is possible only with a significant expansion of the extrahepatic bile ducts, which in most cases is accompanied by a thinning of their wall, which can be additionally injured when the cuff is inflated. With a decrease in bile hypertension, it is difficult to control the adequacy of the cuff inflation with a decrease in the diameter of the ducts.

When a suspension of sorbent is introduced into the bile ducts, it is practically impossible to accurately calculate the required volume to completely fill them. Complete elimination of the introduced sorbent is difficult due to its physical properties and the complex architecture of the biliary tract, while the remaining fragments of the sorbent cause microtraumatization of the inflamed duct mucosa. The use of a sorbent allows partial removal of the contents of the ducts without an active effect on the inflamed wall, and furatsilin as an antiseptic has obvious drawbacks, since it is not effective enough with the pyogenic nature of inflammation and does not have a necro-fibrinolytic effect (Struchkov V.I. et al., 1991) . In addition, nitrofurans are a hepatotoxic drug compound. It is also known that continuous flow-washing drainage has clear advantages over the fractional method (Struchkov V.I. et al., 1991).

To increase the effectiveness of treatment, in particular, to shorten the rehabilitation of the biliary tract and reduce complications, external drainage of the extrahepatic bile ducts is carried out with washing with sodium hypochlorite and intraportal infusion of sodium hypochlorite with the introduction of drugs.

The method is as follows.

After sanitation of the purulent-destructive lesion by removing it (cholecystectomy, opening of cholangiogenic abscess, etc.), choledochotomy is performed, extra- and intrahepatic ducts are audited according to the generally accepted technique, including choledochoscopy. A microirrigator is installed in the hepaticoholedoch, which is removed to the skin through a separate puncture and fixed. Sodium hypochlorite is introduced through it dropwise in 150-200 ml of a 0.02% solution 3-4 times a day for 7-14 days. The introduction of sodium hypochlorite alternate with the introduction of antibiotics, metrogil, heparin.

In parallel with the above measures, recanalization and catheterization of the umbilical vein is carried out with the end of the catheter inserted, bypassing the wellhead valve into the portal vein lumen. Intraportal action is carried out both by traditional means (antibiotics, metrogil taking into account single doses, as well as up to 75% of the daily volume of infusion therapy - reopoliglyukin, glucosonocaine mixture, polyionic solutions, albumin and other blood substitutes), and sodium hypochlorite 0.04% solution 50- 80 ml 3 times a day. Intraportal infusion therapy is carried out from 7 to 14 days, individually varying depending on the laboratory parameters of the portal and caval blood, as well as the dynamics of the general condition of the patient.

The microirrigator is removed after bacteriological examination of bile, stopping signs of acute cholangitis and improving the general condition of the patient.

Thus, the proposed method implements the classical approach in the treatment of purulent-destructive process - removal, drainage and rehabilitation through the biliary tract. The old rule “where the pus is there is a cut” is reflected here as nowhere better.

Comparing the inventive method with analogues, it is clear that it has significant differences, allowing to achieve a new effect.

If the prototype provides for the rehabilitation of only the biliary tract, then in the proposed method, both the portal pool and the biliary tract are simultaneously sanitized, which is much more effective and meets the doctrine of modern surgery, allowing you to effectively use the principles of local exposure. If in the prototype for sanitation only sorbent with furatsilin is used, then in the proposed method, the therapeutic effect is achieved by using the strongest antiseptic - sodium hypochlorite, alternating with an antibiotic, metrogil. In addition, the improvement of portal blood flow is carried out using reopoliglyukin and other infusion agents. Improving microcirculation normalizes liver function and stimulates lymph production. It is known that normal pressure in the arterial bed is 150 mm of water. Art. (120/70 mm Hg), while the portal vein pressure is 10 mm of water. Art. (7 mmHg). Due to the low pressure in the portal vein, which accounts for 30-40% of the total blood flow, the blood circulation speed is lower than in the arterial bed. This is the anatomical and physiological basis of intraportal therapy. The volume of blood flow in the portal pool is less than the systemic one, which provides the maximum therapeutic effect of the injected drugs, since there are more drugs per unit area of the target cells than when introduced into the general bloodstream. With the accumulation of microbial colonies in the hepatoportal system, generally accepted routes of administration are less effective due to the uneven distribution of antibiotics in the body (due to the presence of biological filters - lungs, kidneys). To achieve an antibacterial effect with intraportal administration of antibacterial drugs, the dose of antibiotics can be reduced by 3-7 times, which reduces the side effects of antibiotic therapy, reduces the risk of intestinal dysbiosis, allergic reactions, and bringing plastic, energetic material and metabolic components to the place of their synthesis and assimilation favorably affects the reparative processes in the liver.

The introduction of solutions into the portal vein avoids overload of the pulmonary circulation observed during transfusion into the vena cava (especially in patients with weakened, elderly patients with concomitant diseases of the respiratory and cardiovascular systems). Vascular catheters in the umbilical vein are not prone to thrombosis due to the lack of active blood flow in it.

Clinical examples:

1. Patient Nikitina 63 g., Was taken to the clinic on 05/05/2000 with a diagnosis of Acute destructive cholecystitis. Abscess of the liver. Sepsis. During the examination, stones in the gall bladder, free fluid in the abdominal cavity, cavity formation in the liver of more than 15 cm were revealed at the department hospital. Upon admission, the condition is serious, body temperature 39.2 degrees, icteric skin, scratching. Breathing is quickened. With percussion on the right in the lower sections, dulling. Heart sounds are quickened. HELL - 160/90 mm. Pulse 90 per minute. Complete blood count: L - 18.2 × 10 ⁹ / L, HB - 98 g / L, alpha-amylase - 442, transaminases increased, bilirubin 84 μmol / L, direct 22 μmol / L. NMR - in the right lobe, a fluid cavity formation in 5, 6, 7, 8 segments of the liver, stones in the gall bladder, bile ducts, and a slight densification of the head of the pancreas are visible. When puncture the right pleural cavity received 120 ml of serous-hemorrhagic fluid. After preoperative preparation, an operation was performed within 12 hours - an abdominal cavity was opened obliquely under intubation anesthesia - there was a serous-hemorrhagic effusion with an admixture of bile - 400 ml. Around the gallbladder there is a loose infiltrate, after separation of which it was revealed that the gallbladder is gangrenous, there is a covered perforation through which bile with pus is secreted. A dense mass is determined by palpation in the common bile duct, stones are also palpated in the gall bladder. Performed cholecystectomy with separate ligation of the cystic artery and duct. Produced supraduodenal choledochotomy. 6 stones with a diameter of 0.5-2 cm were removed from the choledoch. In the choledoch, muddy bile with putty, pus. Buzh No. 4 passes freely into the duodenum. Fibrocholechoscopy was performed - purulent-fibrinous cholangitis with damage to the ducts of the right lobe. From the ducts of the right lobe - pus mixed with bile. The choledochoscope passes into the duodenum 12. The duct system is sanitized with antiseptics. Separate drainage of the right hepatic duct through the stump of the cystic duct was carried out. Performed drainage of the common bile duct according to Kerth. An umbilical vein was isolated, recanalized, and catheterized. The catheter is removed through a separate puncture in the right hypochondrium. A puncture of fluid formation was performed on the lower surface of the liver at the lower edge - pus was obtained. An abscess was opened on a needle, 900 ml of pus with an admixture of bile was removed. The abscess cavity was revised, pockets were opened, washed with hydrogen peroxide, furatsilin, drained by a 2-lumen tube, fixed to the capsule, peritoneum, removed through a separate puncture in the right hypochondrium. The abdominal cavity is drained along the Spasokukotsky tubes in the right hypochondrium, iliac regions. There is no other pathology. The wound is sutured in layers. The postoperative period was difficult. A bacteriological examination of the contents of the abscess revealed E. coli, sensitive to metrogyl, tetracycline, cephalosporins. In the postoperative period, the patient was treated as septic. Sodium hypochlorite, metrogil, and antibiotics from the group of cephalosporins were introduced through the umbilical vein. Sodium hypochlorite, metrogil, heparin, antibiotics were introduced into the ducts. The abscess cavity was treated according to the principle of flow-aspiration drainage. For 18 days, an elevated temperature remained. From the caval blood on day 6, the crops were sterile. The vein catheter was removed on day 14. After fistulography from the common bile duct, the drainage was removed on the 15th day. The catheter in the choledochus was up to 16 days. The drainage in the abscess cavity was tightened and was removed on day 22. The drainage was replaced with a thinner one, which stood for another 2 weeks. Discharged after 38 days, partial suppuration of the postoperative wound. Examined after a year - ultrasound, CT - no gross changes in the liver were found. The dimensions of the organ are reduced, the structure is densified in the right lobe.

2. Patient Samsonov, 73, was taken to hospital with a clinic for obstructive jaundice. Sick since 1944, was repeatedly examined. Diagnosed with gallstone disease, chronic calculous cholecystitis. He refused the proposed operation. Upon admission, the condition is severe, severe jaundice (bilirubin: total - 220, direct - 84 μmol / l). Ultrasound - stones in the gallbladder, a thickened wall of the gallbladder, stones in the extrahepatic bile ducts. With RPCH, there are a lot of stones in the enlarged common bile duct. Contrast enters the gallbladder (many stones are also determined). After examination and preoperative preparation for the phenomena of increasing obstructive jaundice and signs of local peritonitis, an operation was undertaken. Access - oblique incision in the right hypochondrium. In the abdominal cavity, an effusion muddy with bile impurity, the gall bladder in the infiltrate with a periprocess, which extends to the hepatoduodenal ligament. Its elements do not differentiate. The bubble is mobilized. Performed cholecystectomy from the bottom. When processing the neck of the gallbladder, it was not possible to separate the artery and cystic duct separately. After isolation of the gallbladder, a complete intersection of the common bile duct was found below the bifurcation by 1 cm. From the extrahepatic bile ducts, bile enters with flakes, pus. Fibrocholechoscopy was performed through the defect in the duct - 10 stones were removed from the distal section. We pass the large duodenal nipple for bougie No. 4. The ducts are washed, the ends of the bile duct are mobilized. Diastasis over 5 mm. With further mobilization of the distal stump, the cystic duct was found (it is 1 cm longer than the distal fragment). Formed end-to-end hepaticocystic anastomosis. Anastomosis oblique-cross, oval. Its diameter is 40% greater than the diameter of hepaticoholedoch. Hepaticotomy was performed proximal to the anastomosis. A drainage according to Keru is installed in the lumen. In this case, the proximal branch is dissected along and inserted into the lobar ducts. Parallel to the T-shaped drainage, a catheter is inserted into the choledochus, and the opening in the duct is sealed. The catheter and drainage are removed through a separate puncture to the abdominal wall. The umbilical vein is isolated, bougie and catheterized. The abdominal cavity is sanitized, drained according to Spasokukotsky. The postoperative period was tense. The patient had a high temperature for a long time. Intraportal therapy was carried out, antibiotics, reopoliglyukin, sodium hypochlorite, metrogil were introduced. Antibiotics, metrogil, sodium hypochlorite, heparin were also introduced through a catheter in the bile ducts. By the end of 2 weeks, body temperature returned to normal, bilirubin dropped to normal numbers. The patient began to walk. The catheter from the vein is removed. The catheter in the ducts was 17 days. Fistulocholangiography was performed twice. Contrast entered the duodenum. No streaks noted. Intrahepatic ducts in dynamics decreased in size. After 5 weeks from the moment of admission, the patient was discharged for aftercare in the Central Hospital. It was recommended that the ducts be flushed through the drainage. 2 months after discharge, the patient was hospitalized due to accidental extraction of drainage. Fistulography was performed through the fistula - we pass the large duodenal papilla, there are no signs of stenosis and stones. A catheter is installed in the fistula. The patient was discharged. The patient was again hospitalized after 1.5 years with a clinic of obstructive jaundice. Ultrasound revealed enlarged extra- and intrahepatic ducts, a suspicion of stones in the ducts. After discussion, percutaneous transhepatic duct drainage was performed. Tubular drainage freely passed through the anastomosis zone and its end was 3 cm from the large duodenal papilla. In the ducts are the shadows of stones. For 3 months, drainage was carried out, jaundice was stopped, stone shadows remained. It was decided to operate on either transduodenal papillosphincterotomy or the application of a biliodigestive anastomosis. Laparotomy with excision of the old scar. An abdominal mass with 10 ml of bile was opened, into which a choledochotomy opening opens below the anastomotic zone. In the common bile duct drainage. Parallel to the drainage, a bouge was carried out. Duodenotomy, papillosphincterotomy were performed, stones were removed from the distal part of the common bile duct. The duodenotomy opening is sutured, a nasoduodenal probe is installed. An attempt to re-catheterize the umbilical vein is unsuccessful. The choledochotomy opening is sutured. The abdominal cavity is drained. The postoperative period was difficult. Transhepatic drainage removed after 1 month. A year later, the patient was again hospitalized with a clinic of jaundice, stricture of the common bile duct was suspected. In this connection, it was decided to reoperate - a pronounced adhesion process (when performing intraoperative duodenoscopy, the endoscopist observed the loss of 7 large stones from the opening). A "malignant" form of the course of cholelithiasis, with the constant formation of stones in the ducts, has been established. On the 7th day, the patient died of myocardial infarction. The section of the liver is stagnant. Small cholangiogenic abscesses in almost all segments, small stones in the intrahepatic prophets. The area of the anastomosis is somewhat narrower than the underlying departments.

3. Patient Tarasova, 53, medical history No. 1341, was admitted to the hospital urgently with manifestations of obstructive jaundice, exacerbation of chronic calculous cholecystitis. With ultrasound in the projection of the gallbladder, a lot of echo signals, moderate expansion of the common bile duct. Prescribed conservative therapy, examination, during which the diagnosis of calculous cholecystitis is confirmed, choledocholithiasis is suspected. Urgently operated. During surgery, the gallbladder is enlarged, inflamed, in a moderate periprocess, the hepatoduodenal ligament is compacted. The choledoch is expanded, stones are palpated in the lumen of the gallbladder and choledoch. Produced cholecystectomy from the neck and bottom due to the intrahepatic location of the bladder. In the process of isolating the gallbladder body from the liver, an intrahepatic cholangiogenic abscess with a volume of about 90 ml was opened, 3 pigment stones were washed from the abscess cavity. Bleeding is stopped, the abscess cavity is sanitized, temporarily plugged. Performed choledochotomy. 2 large stones and many small ones were removed from the common bile duct. Bile with an admixture of pus, sand, was released under pressure. We pass the large duodenal papilla for bougie No. 4. A choledochoscopy was performed, during which it was found that pus comes from the right lobe of the liver, anterior segments. A drainage was established in the common bile duct according to Kerth, a microirrigator was inserted into the right hepatic duct. A separate tube is installed in the abscess cavity. The bed is sutured in places of contact of the edges of the defect. The abdominal cavity is drained according to Spasokukotsky. The tubes are brought to the abdominal wall. The umbilical vein is isolated and catheterized. The catheter is fixed. The postoperative wound is sutured in layers tightly. In the postoperative period, sodium hypochlorite, antibiotics, metrogil, heparin were injected into the common bile duct according to the scheme through a microirrigator. Bacteriological control of bile was carried out. Flow-suction drainage of the abscess cavity, intraportal therapy, including antibiotics, metrogil, sodium hypochlorite. The drainage from the abdominal cavity was removed on the 7th day. Control cholangiography was twice performed through drainage in the common bile duct and through drainage in the abscess cavity, the cavity of which communicated with the bile ducts. A complete reorganization of the common bile duct was achieved. Drainage from the choledochus was removed on the 18th day, from the abscess cavity - on the 24th day. Within 2 weeks, a bile fistula functioned, which independently closed.

The histological conclusion is phlegmonous ulcerative cholecystitis. In a bacterial study, E. coli., Sensitive to cephalosporins and aminoglycosides, was obtained from the abscess cavity. Intraportal therapy was carried out for 12 days. After normalizing the temperature, the catheter was removed. Discharged with recovery after 46 days. Partial suppuration of the postoperative wound. Examined after six months - healthy.

This treatment method was used in 18 patients, the comparative treatment results of which are presented in the table.

Table 1 The results of the treatment of patients with purulent-destructive cholecystocholangitis according to the proposed method and clinical comparison group Treatment indicator
Type of complication According to the proposed method Clinical Comparison Group n = 18 % ± S% n = 20 % ± S% Bed day 26 ± 3.8 - 37 ± 4.6 - Mortality one 5.56 ± 5.40 four 20 ± 8.94 Purulent necrotic complications of the abdominal wall and abdominal cavity one 5.56 ± 5.40 6 30 ± 10.25 Cholangiogenic abscesses - - four 20 ± 8.94 Cholangiogenic sepsis - - four 20 ± 8.94 Repeat operations one 5.56 ± 5.40 3 15 ± 7.98 Gall fistula - - 2 10 ± 9.49 Biliary Pancreatitis - - 2 10 ± 9.49

Bibliography

1. N.A. Maistrenko, V.V. Stukalov. Choledocholithiasis. - SPb .: ELBI - SPb, 2000.

2. Atyasov N.I. The system of active surgical treatment of seriously burned. Gorky: Volgo-Vyat., Prince. Because, 1972, p. 384.

3. RF patent No. 1729494. A method for the treatment of obstructive jaundice / Ivshin V.G., Lukichev O.D. According to the application No. 4705713/14. Declared June 19, 89. M.cl. A 61 B 17/00. Publ. 04/30/92. B.I. No. 16 ..

4. Surgical infection: a guide for doctors (2nd ed., Rev. And add.) / V.I. Struchkov, V.K. Gostishchev, Yu.V. Struchkov / Academy of Medical Sciences of the USSR. -M .: Medicine, 1991, 560 p.

5. Bictorov O.P., Porokhnyak L.A. Partial pouring of liquids on the stove // Liki. - 1996. - No. 1. - S.3-13

6. A practical guide to anti-infectious chemotherapy / Edited by L. S. Strachunsky, Yu. B. Belousov, S. N. Kozlova.

7. RF patent No. 1120980. A method for the treatment of liver failure / Shalimov S.A., Zubkov V.I., Skiba V.V., Shevchenko V.M., Tarapon O.Yu., Bobrov O.E. According to the application No. 3462119 / 28-13. Claimed on 05.20.82. M.cl. A 61 B 17/00. Publ. 10/30/84. B.I. Number 40.

8. Reshetnikov EA, Chuvanov MV, Denisov A.Yu. and Shipilov G.F. Extracorporeal detoxification in the complex treatment of surgical sepsis. Surgery them. Pirogov No. 1, 2001.

9. USSR author's certificate No. 1599022, MKI 5 A 61 M 1/00 / Method for conducting intraductal sorption detoxification / V. P. Andryushchenko, D. A. Makar.

Claims (1)

A method of treating purulent cholangitis, including drainage, washing of the bile ducts, characterized in that the washing is carried out with a 0.02% solution of sodium hypochlorite in a dose of 150-200 ml, drip, 3-4 times a day for 7-17 days, and through a catheterized portal vein, 0.04% sodium hypochlorite of 50-80 ml is administered 3 times a day during infusion therapy using traditional medicines for 7-14 days as well.