Object of the study: the course of acute biliary pancreatitis (ABP) depending upon the approach mastered. Purpose of the study: grounding of the tactics for the surgical treatment of patients with ABP by the way of studying the pathogenetic mechanisms of the disease development in a experiment, the study of diagnostic and immunological criteria of the disease course. Methods of the investigation: general clinical, biochemical, immunological, immunoenzyme, electronic-microscopic, roentgenological, instrumental (endoscopic gastroduodenoscopy, retrograde pancreatocholangiography, ultrasonography) and statistical methods. Theoretical and practical results: some specificity and informative character of disorder signs for the draining functions of the ductal system in different types of ABP modeling were revealed, thereby making it possible to use them for monitoring the efficacy of differentiated surgical treatment of patients depending upon the variant of ABP pathogenesis. Threshold values of the humoral-cellular indices, characteristic of different ABP severity degrees were found out, they enabling clinicians to make a long-term prognosis for the therapy efficacy. Compensation norms for the organism homeostasis indices in ABP patients were established; they significantly differ from the population ones and make it possible to individualize the correction of metabolic disturbances. Algorithms of the favourable and unfavourable prognosis for the survival of ABP patients with seconddary pancreatic infection (SPI) were developed by clinical-laboratory and immunopathological signs. The algorithms were synthesized with regard of the most informative indices. They are simple and accessible for being used by doctors of health protection institutions. The revealing of the type of immune disorders makes it possible to coordinate the direction of the immunomodifying therapy against a background of the combined treatment of patients with a complicated course of ABP. The suggested ways for prognosticating and combined treatment made it possible to reduce both the lethality in aseptic pancreonecrosis and the possibility of developing SPI with lethality in the septic phase of ABP course. The semiquantitative method for detecting the level of procalcitonin is a convenient and accessible diagnostic method, which should be used at the patient’s bedside; it serves as a reliable marker of SPI development. New surgical protocols were suggested; they can be used in low-invasive, semiopen and open surgical interventions for treating patients with ABP and its complications with a resultant reliable reduction of the percentage of postoperative complications and postoperative lethality. Novelty: the cholecystic, cholangitic, papillary and combined experimental models of ABP, as well as their infected forms, were reproduced, thereby making it possible to reveal the adequate schemes of surgical correction. The leading role of the dystrophic process expression degree of the acinus cell ultrastructures in the development and complications ofABP process was found out, the most important part being played by the mitochondrial function. A degree of the relationship between the cellular and humoral immunity indices owing to genetic factors (HLA-A, B, DR+ systems) was determined depending upon the phase of ABP course. The obtained results of the researches made it possible to formulate a concept for the development of destructive complications of ABP, as well as objective criteria for assessing the disease course, to reveal the degree of the patient’s severity and operational risk. A mathematical model was formed for prognosticating a degree of the ABP course severity on the basis of using the standard indices of homeostasis. Schemes for the effective treatment of patients with ABP and its complications on the basis of assessing factors for the development of the systemic inflammatory response syndrome were worked out. Degree of introduction: the suggested diagnostic-tactical schemes for treating patients with ABP have been introduced into the clinical practice of specialized departments of the Institute of General and Urgent Surgery of the Academy of Medical Sciences of Ukraine, Kharkiv Regional Hospital, multi-type Kharkiv City Hospital No. 17, Merefa Central District Hospital, Dergachi Central District Hospital, Dnipropetrovsk Medical Union of Urgent Aid. The results of the researches are used in the educational process of Department of Hospital Surgery No. 1 of Kharkiv National Medical University. Sphere of application: medicine, surgery
