Gajdash O. The choice of miniinvasive method of complicated cholelithiasis surgical treatment in patients with high-operative risk

The dissertation is dedicated to the increase of complicated cholelithiasis surgical treatment efficiency in patients with high-operative risk. All patients were divided into the main and comparative groups by sex, age, diseases and accompanying diseases. Both groups were identitcal. In the comparative groups miniinvasive and traditional operative measures were used with standard anaesthesiologic security. In the main group, the choice of miniinvasive method of operative procedure was formed on the basis of elaborated algorithm including the assessment degree of clinically dominated surgical pathology, polymorbidnity index, intoxication index, the average mass molecules'increase. In the comparative groups the analysis of treatment tactics showed, that in spite of the tendency to carry out miniinvasive operative procedures (LCHE, EPSPHT and LCHE - 60,8 %) the death-rate made 11,3 %. In the main group where miniinvasive operative procedures and anaesthesiologic security with regional methods of anaesthesia and laryngeal Bran's mask were used, the death-rate was managed to be reduced to 1,9 %. Elaborated algorithm of the complex of surgical procedures miniinvasive methods and anaesthesiologic security is based on chosing compensative and decompensative types of integral functional indexes of cardiorespiratory system, endogenic intoxication markers, clinical versions of cholelithiasis complications. Finally, comparing the results of surgical treatment of patients with high-operative risk in the main and comparative groups, the elaborated algorithm of miniinvasive procedures choice using regional methods of anaesthesia (subpleural, epidural) allowed to descrease the amount lethal outcomes in the main group to 1,9 % that is 5,9 times less than in the comparative one.