Аннотация

Цель
To improve the treatment results of patients with acute calculous cholecystitis complicated by reactive hepatitis with jaundice based on the improvement of surgical tactics using minimally invasive technologies
Материал и методы
The study is based on the results of treatment and examination of 95 patients with ACC complicated by NGC and jaundice. Taking into account the conducted research methods and the choice of treatment tactics, the patients were divided into two groups: 55 (57.9%) patients of the main group, who underwent modern research methods and treatment according to the algorithms developed in the clinic, 40 (42.1%) - the control group, who received standard diagnostic and treatment methods.
Результаты
There were 58 women (61.0%), 37 men (39.0%), aged 20 to 58 years. The average age was 38.1 ± 19.9. The majority of the patients (n=89) sought specialized care more than 24 hours after the onset of hepatic colic. In 7 of 14 cases (50.0%) with phlegmonous changes in the gallbladder wall, cholecystectomy from the neck was performed. In 6 cases (42.8%), due to severe infiltrative-inflammatory processes in the neck area, preventing its verification, LCE was performed from the bottom. In one case (7.2%), a laparoscopic version of the Pribram operation was performed for clinical and intraoperative indications. Among patients with gangrenous cholecystitis (n=11), LCE from the neck was performed only in 2 patients (10.5%). In the remaining patients, alternative methods were used: 8 (42.1%) underwent laparoscopic cholecystectomy from the bottom, 4 (21.0%) — the Pribram operation, and 5 (26.3%) — subtotal cholecystectomy. Among 40 patients (42.1%) who underwent laparoscopic cholecystectomy, complications in the early postoperative period were recorded in 9 cases (22.5%), of which 3 (7.5%) were fatal.
Заключение
The choice of the laparoscopic cholecystectomy method for various forms of gallbladder wall destruction should be differentiated and determined by the nature and degree of local inflammatory and destructive changes, the presence of local and systemic complications, as well as the severity of concomitant somatic pathology.

Ключевые слова

acute calculous cholecystitis hepatitis jaundice laparoscopic cholecystectomy.

Полный текст

Скачать статью в PDF

Полная версия статьи в формате PDF

Список литературы

  1. Абдулжалилов М.К., Абдулжалилов А.М., Иманалиев М.Р. Субоперационные технические сложности при лапароскопической холецистэктомии у пациентов с острым калькулезным холециститом.
  2. Addissouky T.A., Ali M.M., Sayed I.E., Wang Y. Emerging advanced approaches for diagnosis and inhibition of liver fibrogenesis. Egypt J Intern Med. 2024;36(1):19. DOI:10.1186/s43162-024-00283-y.
  3. Кашаева М.Д., Прошин А.В., Швецов Д.А. Морфофункциональные изменения печени и почек при холестазах. Вестник Новгородского Государственного университета. 2019;1(113):34-38.
  4. Addissouky T. Detecting liver fibrosis by recent reliable biomarkers in viral hepatitis patients. Am J Clin Pathol. 2019;152:85. DOI:10.1093/ajcp/aqz117.000.
  5. Addissouky T.A., Elbaz A., Moneim A., Torgoman E.I., Sayed E.I. Efficacy of biomarkers in detecting fibrosis levels of liver diseases. World J Med Sci. 2019;16(1):11-18. DOI:10.5829/idosi.wjms.2019.11.18
  6. Chang C.H., Wang Y.Y., Jiao Y. Hepatitis A virus-associated acute acalculous cholecystitis in an adult-onset Still’s disease patient: a case report and review of the literature. World J. Clin. 2023;11(6):1410-1418.
  7. Kumari R., Rajeev R., Jaiswal P., et al. Gallstone-Associated Histopathological Changes in Liver: A Prospective Observational Study. Cureus. 2024;16(3):e55417. doi: 10.7759/cureus.55417.
  8. Wang S.Y., Chun N.Y., Yi Y.J., Miin F.Ch. Management of Gallstones and Acute Cholecystitis in Patients with Liver Cirrhosis: What Should We Consider When Performing Surgery? Gut Liver. 2021;15(4):517-527. doi: 10.5009/gnl20052.
  9. Дибиров М.Д., Рыбаков Г.С., Домарев В.Л., Васильева М.А., Бродецкий Б.М., Косаченко М.В. Алгоритм диагностики и лечения больных пожилого и старческого возраста с острым холециститом, холедохолитиазом и механической желтухой. Журнал им. Н.В. Склифосовского Неотложная медицинская помощь. 2017;6(2):145-148. DOI: 10.23934/2223-9022-2017-6-2-145-148.
  10. Махмадов Ф.И., Каримов П.Ш., Мирбегиев Дж. К вопросу о холецистэктомии при остром калькулёзном холецистите у больных с высоким операционно-анестезиологическим риском. Вестник Академии медицинских наук Таджикистана. 2019;1(29):40-46.
  11. Manudhane A.P., Leupold M.D., Shah H.W., et al. A review on endoscopic management of acute cholecystitis: endoscopic ultrasoundguided gallbladder drainage and endoscopic transpapillary gallbladder drainage. Medicina (Kaunas). 2024;60(2):212. DOI: 10.3390/medicina60020212.
  12. He L., Chen Z., Wang Z., Pan Y. Enhancing patient outcomes through nursing care in laparoscopic common bile duct exploration; a randomized control trail. J. BMC Surg. 2024;24(1):360. doi: 10.1186/s12893-024-02657-z.
  13. Xu S., Deng Ch., Tang K., et al. The effect of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration in treatment of cholecystolithiasis combined with choledocholithiasis. Updates Surg. 2025;77(2):493-499. doi: 10.1007/s13304-025-02110-7.
  14. Махмадов Ф.И., Мирбегиев Дж., Каримов П.Ш. Мини-инвазивная коррекция ранних послеоперационных осложнений лапароскопической холецистэктомии. Московский хирургический журнал. 2018;3(61):12-13.