Tactical and technical aspects of complex treatment of patients with acute destructive cholecystitis complicated with peritonitis and billary sepsis
DOI:
https://doi.org/10.34287/MMT.2(41).2019.7Abstract
Purpose of the study. To clarify the clinical and diagnostic criteria of BS, caused by complicated acute destructive cholecystitis for the development of optimal treatment tactics.
Material and methods. 193 patients with acute destructive cholecystitis and choledocholithiasis, complicated by peritonitis, had surgery on the basis of Odessa regional clinical center in the clinic of surgery № 2. All patients with BS were divided into two groups. In the first group, 115 non-invasive laparoscopic surgical interventions were performed. In the second group, 78 patients were performed laparotomy, cholecystectomy, choledochotomy and external drainage of choledoch duct, as well as external drainage of CAL.
Results. In patients with BS and obstructive jaundice, prior emphasis was placed on active surgical tactics, the use of noninvasive technologies in combination with intensive infusion and antibiotic therapy. Of great importance in the treatment of BS was also given to hemodynamic and respiratory support, detoxification with the use of efferent methods (hemosorption, plasmapheresis), rational antibiotic therapy, immunocorrection, antioxidants, and vitamin therapy.
Conclusions. Adequately initiated treatment with the use of modern methods of diagnosis and conservative therapy, surgical interventions in the early stages, reduces the percentage of development of severe complications and the number of fatal cases in this pathology. In perspective, it is necessary to determine more precise markers of biliary sepsis at an early stage, to improve methods of endoscopic surgery and detoxification treatment.
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