Zeleniuk O. Diagnosis and surgical treatment of extrahepatic cholestasis in complicated cholelithiasis

The dissertation work presents a theoretically substantiated and confirmed in a clinical study a new solution to a scientific problem, which consists in improving the results of diagnosis and surgical treatment of patients with extrahepatic cholestasis (EHC) with complicated cholelithiasis (CL) by using the developed combined manodebitometry and dosed balloon papilodilation, aimed at preservation of the functional and anatomical integrity of the sphincter of Oddi (SO). Based on changes in biochemical markers of cholestasis, the types of EHC in complicated CL were identified, which, in fact, are pathogenetic stages of one process. The analysis of heart rate variability indices in patients with various types of EHC revealed the predominance of hypersympathicotonia in patients with EHC (69.2%) of functional genesis (p <0.05). It was determined that morphofunctional changes in the liver in complicated CL depend on the type of EHC. A relationship was established between the parameters of the stiffness of the liver parenchyma and the pressure in the bile duct according to manometry data (r = -0.87; p <0.001), which makes it possible to use the shear wave elastometry method in dynamic control of the functional state of the liver in the postoperative period. A strong direct relationship was revealed between the indicators of liver stiffness and the diameter of the common bile duct and the level of total bilirubin (r = 0.75; p <0.05 and r = 0.84; p <0.001), respectively. The developed method of combined manodebitometry with a pharmacological test for relaxation of the SO has a high diagnostic value (sensitivity 93.60%, specificity 80.00%, accuracy 88.90%) using the established manodebitometric coefficient as a diagnostic criterion, and allows you to determine the causes of EHC with complicated CL and their origin. The developed diagnostic and treatment algorithm algorithm made it possible to establish the presence and causes of EHC, and the use of sphincter-preserving parameters of papilodilation made it possible to reliably reduce the development of early postoperative pancreatitis and long-term complications, as well as significantly improve the indicators of the physical and psychological components of patients' health in comparison with the use of traditional surgical tactics.