The dissertation is devoted to the peculiarities of diagnosis, course and individualization of therapeutic management of patients with acute calculous cholecystitis complicated perivesical infiltrate considering its density, prevalence and use endovideosurgery priority interventions to improve treatment outcomes and quality of life. The work is based on the results of examination and surgical treatment of 103 patients with acute calculous cholecystitis complicated perivesical infiltrate. Based on morphological studies found that patients with higher weight percentage of low-functioning lymphatic capillaries, increased intensity of the inflammatory response and the degree of tissue damage. Purpose lymphotropic therapy is a pathogenetically justified in patients with a dense infiltrate. We have developed a method of determining the degree of infiltration distribution. Analysis of changes in hematological indices in patients with acute calculous cholecystitis complicated perivesical infiltrate. Established significant difference (r<0,05), LII, IRLG, IVL-ESR between groups depending on the state of infiltration. The content of middle mass molecules also had a significant difference depending on the nature of infiltration. Was founded elevated levels of fibrinogen reduction and APTT prolongation of prothrombin time in patients with friable infiltrate, indicating the development dyskoagulation. The research results showed the intestinal macrobiotic formation of intestinal dysbiosis, which was characterized by inhibition of defence response, the development of pathogenic microflora on a background disturbance of digestion and accumulation of toxic metabolic products that may have predictive value for the diagnosis of postoperative complications, improve treatment outcomes and quality of life by individualization of treatment programs. In the study of immunity found that in the group with friable and in the group with dense infiltration contents of CD 3+ - 8+ CD - and CD 4+ -lymphocytes and contents of B-lymphocytes (SD19+) significantly (r<0,05) was increased compared to the control group. Factor apoptosis (FAS (CD95), polypeptide content - endothelin-1 in patients with dense infiltrate significantly increase (r<0, 05). Differences of interleukins, neutrophil phagocytic activity depending on the form perivesical infiltrate are not established. The concentration of CIC was on top limit indicators of healthy people. The main technical difficulties and peculiarities performance laparoscopic cholecystectomy in terms perivesical infiltrate implementation of operational interventions differences depending on the BMI developed tools for the prevention of iatrogenic damage, use of regional lymphotropic therapy. The proposed tactic helped reduce complications in the study group 2,99%. We evaluated the results of treatment for 5-7 days after surgery. Positive results of classification Visik 7,3% higher in the study group, shortening of treatment by 3,4% in the friable infiltrate and 7,3% in the dense infiltrate. Quality of life of patients with acute calculous cholecystitis complicated friable infiltrates in the main study group improved by physical health component by 9,3% and the mental health component by 8,9%. In dense infiltrate achieved better physical health component by 8,7% and the mental health component by 8,8%. The effect of the application proposed treatment strategy in patients with different types of perivesical infiltrate more significant in patients with friable infiltrate, by improving the physical health component by 9,4%. The share component of mental health has not significantly changed.
