Индивидуализация тактики ведения больных механической желтухой при остром калькулезном холецистите

This paper presents a retrospective statistical analysis of 251 cases of acute calculous cholecystitis complicated by obstructive jaundice during the period from 2007 to 2012. Depending on laboratory, instrumental and intraoperative data, patients were divided into three groups corresponding to obstructive jaundice pathogenic stages. First group was formed from patients with only symptoms of cholestasis. Patients from the second group had elevated liver transaminases in blood in addition to cholestasis symptoms. Third group included patients with purulent-inflammatory complications and renal failure. Multivariate analysis of variance was performed to find the most informative biochemical and instrumental symptoms for each stage of obstructive jaundice. The most informative features for obstructive jaundice staging are: index of De Ritis, the ratio of total bilirubin level to indirect bilirubin level, level of amylase in blood, white blood cell count, leukocyte index of intoxication in Reis modification, double contour of gallbladder wall and pancreas size increase by ultrasonography.These symptoms can accurately determine obstructive jaundice stage and corresponding treatment strategy. In first stage it is possible to perform radical surgical procedures inone step. Patients with signs of hepatic failure need intensive therapy before surgery. In these cases, the minimally invasive techniques may be used for decompressing. Radical surgery should be performed as a second step. Patients with terminal obstructive jaundice require intensive therapy and emergency surgery. Surgical treatment is aimed at relief of the inflammatory process in the biliary tract. The second step can be performed radical surgery.