Ievtushenko D. Optimization of the program of surgical treatment for complications of cholelithiasis.

The work is based on the analysis of the results of surgical treatment of 184 patients with complications of cholelithiasis. With prolongation of jaundice from 7 to 30 days, alterative, inflammatory and sclerotic changes in liver tissue increases. Amount of connective tissue increases, size of hepatocytes decreases with prolongation of jaundice, that leads to increase of parenchyma-to-stroma ratio. In 33,7% of patients with choledocholithiasis caused by obstructive jaundice acute cholangitis developed, according to the Tokyo Guidelines 2013 of first degree in 53,3% patients, of second - 41,9%, of third (severe) - 4,8%. Growth of hematological indexes reflects the severity of the inflammatory changes. Pathological process in patients with initial stages of Mirizzi syndrome could be corrected by cholecystectomy with external drainage of common bile duct. For patients with Mirizzi syndrome type IV-V optimal treatment was cholecystectomy with reparation of common bile duct using gallbladder tissue. For patients with Mirizzi syndrome Vb symptomatic treatment preferable due the severity of their condition. On the basis of the received data, we proposed and introduced into clinical practice the new method of hepaticojejunostomy and method for determination of the hematological index "indicator of intoxication". The tactics of surgical interventions for patients with Myrzzi syndrome was unindividualized.