Kramarenko K. Ways of optimisation endoscopic methods of treatment of the complicated form of cholelithiasis and efficiency of their application in non-standart situation.

Object of the study: The cholelithiasis, the complicated obstruction of the bile duct. Purpose of the study: The purpose of thesis was to develop and estimate efficiency of new methods of endoscopic diagnostics and miniinvasive treatment of the patients with complicated forms of cholelithiasis. Methods of the investigation: The standard clinical methods of definition of common analysises of blood and urine, biochemical analysis of blood sugar and urea, a level of a bilirubin and electrolytes of structure in blood were used. The complex of tool examination of bile duct included ultrasound, endoscopy and X - ray methods. Practical significance of the obtained results: The standard complex of tool examination (USD, duodenofibroscopy, ERCP), was added with methods of "diagnostic" EPST, electrothermometries of bile ducts, cholangiomanometry and bacteriological investigation of bile. The algorithm of consecutive application of the specified tool methods of diagnostics has provided the increas up to 96.7 % in accuracy pre-operative diagnostics of bile duct pathology. The cholangiomanometry technique, raising quality of differential diagnostics of stenosis and spastic papillar stricture has been is de-veloped. Novelty: Endoscopic manipulations of the first stage of treatment (EPST, nasobiliary drainage (NBD), the extraction of bile duct stones) were improved considering the non-standard situations. The applied modified nasobiliary drainage allowed to improve the adequate local therapy of purulent cholangitis and stopping of mechanical icterus. The EPST with controlled conductor at locating of papilla in diverticulum allowed to increase the frequency of successful manipulations in such situations up to 87.5 %. Degree of introduction: The developed method was inserted in the work of surgical departments of the urban clinical hospital №2, hospital of veteran of war in the Vinnitsa. The main positions of the thesis are using at reading of the lectures to the doctors KMAPE. Sphere of application: Medicine, surgery.