SAFRO OQMALARI: ETIOPATOGENEZI, KLASSIFIKATSIYASI, KLINIKASI, DIAGNOSTIKASI VA DAVOLASHDA ZAMONAVIY YONDASHUV (ADABIYOTLAR SHARHI)
Abstract
Maqolada safro oqmalarining (biliary leak) etiopatogenezi, zamonaviy klassifikatsiyalari, klinik kechishi, diagnostika algoritmlari va davolashning multidisiplinar yondashuvlari tahlil qilindi. Strasberg–Bismuth, Amsterdam (A–D), Sandha (endoskopik past/yuqori darajali), ISGLS (I–III) hamda ATOM (Anatomy–Time–Mechanism) yondashuvlari integratsiyalangan yangilangan klassifikatsiya taklif etildi. Cholecystectomy, gepatobiliyar rezeksiyalar va echinokokkektomiya (exinokokkektomiya)dan keyingi safro oqmalarining xususiyatlari, shuningdek Luschka (subvezikal) yo‘llaridan kelib chiqadigan oqmalar alohida ko‘rib chiqildi. Diagnostikada USG, drenaj orqali MSKT-fistulografiya, MR-xolangiografiya (hepatotsit-selektiv kontrastlar bilan) va ERXP (zaruratda PTC)ning o‘rni tahlil qilinadi. Davolashda intrabiliyar bosimni pasaytirish tamoyili markaziy o‘rin tutishi ta’kidlandi: endoskopik sfinkterotomiya, stent/nazobiliyar drenaj, ayrim holatlarda to‘liq qoplangan metall stentlar, periferik oqmalarda perktutan embolizatsiya (coil/glue) va murakkab uzilgan segment oqmalarida ‘rendezvous’ yoki segmentni diskonnektni bridging qilish imkoniyatlari muhokama qilindi. Mualliflar amaliyotida MSKT-fistulografiya va MRXQ asosida tashxis qo‘yilib, keyin 2,6 mm xoledoxoskop yordamida nishonli endoskopik aralashuvlar bajarilishi keltirildi. Echinokokkoz bo‘yicha bo‘limda postoperativ oqmalar chastotasi, xavf omillari va endoskopik hamda perktutan strategiyalar bo‘yicha davolash natijalari jamlandi. Natijada, safro oqmalarini oqma joyiga qaratilgan taktika bilan birga intrabiliyar bosimni tizimli boshqarish kombinatsiyasi klinik samaradorlikni oshirishi taklif etiladi.
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