Bryts'ka N. Individualization of biliary tract decompression methods in patients with mechanical jaundice using minimally invasive surgical interventions

Object of the study: Mechanical jaundice syndrome. Purpose of the study: Improvement of surgery outcome in patients with mechanic jaundice of various origin by means of developing and introduction of individualized therapeu-tic approach to bile duct decompression using low invasive surgery. Methods of the investigation: Clinical, biochemical, instrumental (ultrasound study, esophagogastroduodeno-scopy, endoscopic retrograde cholangiopancreatography, intra-operative cholangiography, fistulocholangiography, cholangiomanometry, CT), statistical methods. Practical significance of the obtained results: The obtained findings allowed to substantiate a new strategy of treating the patients with mechanical jaundice of various origin with the help of minimal invasive surgery which allows to avoid liver failure progress after biliary decompression and improve the results of treatment. The sug-gested therapeutic diagnostic algorithm allows differenti-ated approach to application of various minimal invasive procedures of biliary decompression with the account of the origin of the biliary tract obstruction, occlusion level, the character of cholestasis, duration of jaundice and presence of liver failure. The developed method of biliary tract decompression and the device for drainage of the biliary tract allow to improve the course of the disease and results of treatment of the patients with mechanic jaundice. The original method of pressure monitoring in the bile ducts al-lows to assess the degree of biliary hypertension and sub-stantiate an effective dosed biliary decompression. Novelty: For the first time, new pathogenetic aspects of development and progress of liver failure after biliary system decompression in mechanic jaundice were determined and scientifically proven. High correlation between the pressure reduction in the biliary tract after decompression of the biliary tract and increase of volume blood flow in the portal system was established. It was proven that the parameters of severity of one hundred patients integrated in SAPS II scale, clinical biochemical parameters, the finding of ultrasono-graphy, the parameters of hepatosplanchial blood flow allowed to predict the progress of liver failure in mechanic jaundice and could be the indications to biliary decompression using minimal invasive surgery. A method of pressure monitoring in the bile ducts which allows to promote a significant assessment of bile duct drainage adequacy after biliary decompression was worked out. It was established that the use of the suggested new minimal invasive method of bile duct drainage and a device for drainage with a system of internal fixation promoted an adequate decom-pression of the biliary system and reduced the number of post-surgical complications. Degree of introduction: The developed diagnostic systems of treatment of the patients with mechanic jaundice of both benign and malignant origin were introduced to the work of Institute of General and Urgent Surgery (Academy of Medical Science of Ukraine), Kharkiv Clinical Hospital of Urgent Medical Aid named after prof. Meschaninov, Institute of Oncology (Academy of Medical Science of Ukraine). Sphere of application: medicine, surgery.