Кulyk A. Хирургическая тактика и лечение больных с желчекаменной болезнью в сочетании со спаечной болезнью брюшины.

Dissertation work is sent to search a decision of difficult medical and social care - operative treatment of calculous cholecystitis in conditions of adgesion process in abdominal region which is already exist after celiotomies, carried in anamnesis. The amount of postoperative complications remains in high level enough. It testifies that the choice of variant of cholecystectomy for these patients must be individualized and must be based on expression of adgesion process of peritoneum. A problem of prognostication of expression of adgesion process is actual and unsolved in modern surgery today. At presence of many methods of cholecystectomy on the modern stage, it remains not clear which variant of cholecystectomy from the existent ones is most justified for patients with adgesion process of peritoneum, that defined a direction of our research, the purpose of which optimization of surgical tactic and treatment of patients with calculous cholecystitis in combination with adgesion process of peritoneum reduction of terms of treatment of patients has become. An analysis of treatment 106 patients with calculous cholecystitis in combination with adgesion process of peritoneum has been puted in basis of clinical supervisions. Patients were up-diffused in two groups: basic one and group of comparison. The group of comparison contained 50 patients with calculous cholecystitis in combination with adgesion process of peritoneum, which had been applied generally accepted methods of inspection, which had not considered a prevalence of adgesion process. A basic group contained 56 patients which have been applied the worked out approach of determination of expressed of adgesion process on the preoperated stage. Materials of estimation of informing of the preoperated criteria of estimation of expressed of adgesion process of peritoneum are given in clinical part of work, from which it was distinguished two leading criteria - determination of activity of NAT 2, which determines the genetically determined individual propensity to formation of connecting fabric and ultrasound study for determination of from unions clearzones on a front abdominal wall for. As a result of analysis of informing of leading criteria of adgesion process with the use of statistical mathematical analysis the classification of expressed of adgesion process of peritoneum was exhaust. The offered estimation of prevalence of adgesion process of peritoneum algorithms, surgical tactic in a basic group had the reflection in the justified change of priority in the choice of variant of surgical access at cholecystectomy in behalf on mini-invasion technologies.