Haley M. Surgical tactics and the choice of mini-invasive means of operative treatment of patients with obstructive jaundice having benign genesis in the age aspect

The dissertation is devoted surgical tactics and the choice of mini-invasive means of operative treatment of patients with obstructive jaundice having benign genesis in the age aspect. The learning of clinical picture of obstructive jaundice allowed to differentiate the four variants of clinical course depending upon the degree of obturation. Choledocholithiasis (84,2%) was characteristic of all age groups. Sonography with identification of gall-duct’s ultrasound density for defining of degree of its obturation proved the sensitivity of the method in 96%, the endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography – in 100 %. Proved criteria of optimisation of therapeutic approach and improved medical algorithm of searching for mini-invasive means of operative treatment of patients with obstructive jaundice with benign genesis under conditions of taking into account the estimation of seriousness degree of jaundice, OAR class and urgency of operative intervention. Comparative analyses of therapeutic approach in different periods of examination showed that unit weight of mini-invasive video-endoscopic operative intervention in obstructive jaundice with benign genesis was 74,4% , meanwhile the number of these operative interventions has become almost three times larger recently. The suggested diagnosis-therapeutic approach to treatment of patients suffering from obstructive jaundice allowed to lessen the postoperative complications from 20,43 to 6,8 %, and the degree of postoperative lethality from 4,3 to 1,7 %.