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Deikalo I. M., Osadchuk D. V., Karel O. I., Handzhalas M. B. Minimally-invasive technologies in the treatment of choledocholithiasis complicated by purulent cholangitis. Journal of Education, Health and Sport. 2021;11(2):317-334. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.02.030 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2021.11.02.030 https://zenodo.org/record/5559779 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 11.01.2021. Revised: 10.02.2021. Accepted: 26.02.2021. UDK 616.361-002.3-06:616.367-003.7-089.819 MINIMALLY-INVASIVE TECHNOLOGIES IN THE TREATMENT OF CHOLEDOCHOLITHIASIS COMPLICATED BY PURULENT CHOLANGITIS I. M. Deikalo, D. V. Osadchuk, O. I. Karel, M. B. Handzhalas The National Higher Education Institution «I. Horbachevsky Ternopil National Medical University of the Ministry of Health of Ukraine», Ternopil, Ukraine Deikalo Ihor Mykolaiovych - Honored Doctor of Ukraine, Doctor of Medicine, Professor of Surgery, Head of the Department of General Surgery of I. Horbachevsky Ternopil National Medical University. Tel. 067 257 82 96. Osadchuk Dmytro Vasyliovych – Candidate of Medical Sciences, Associate Professor of the Department of General Surgery of I. Horbachevsky Ternopil National Medical University, Head of the Department of Surgery of Ternopil City Municipal Emergency Hospital. Tel. 067 208 69 43. Karel Oleh Ihorovych – Surgeon of Ternopil City Municipal Emergency Hospital. Tel. 097589 28 32, kareloi@ukr.net Handzhalas Mykola Bohdanovych - Surgeon of Ternopil City Municipal Emergency Hospital.Тel. 096 995 89 31 Abstract Minimal invasive endoscopic technologies are used in the treatment of patients with choledocholithiasis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014 - 2018, aged 65.5 ± 15.18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) - surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) - by needle. In all cases, subtotal papilloprotectomy was performed [1], supplemented by balloon sphincteroplasty. In the I group, the patients included patients with acute cholangitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock. In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observed during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of cholangitis and biliary sepsis was noted. Keywords: сholecholithiasis; purulent cholangitis; biliary sepsis; septic shock; endoscopic retrograde pancreatic cholangiography; endoscopic papillomotorotomy. |
