Stets M. Diagnostics and surgical holiatry of toxic-septical biliary syndrome, complicated by polyorganal disfunction

The thesis is devoted to the improvement of direct and remote results of treatment of patients from toxic-septical biliary syndrome, complicated by polyorganal disfunction, by the study of etiology, pathogeny, morphological, biochemical, immunological changes, in comparison with clinical disease activity, on the base of the development of diagnostic and stage comprehensive surgical medical algorithm. Research is based on the results of comprehensive inspection and treatment of 775 patients with the manifestations of toxic-septical biliary syndrome. The analysis of the conducted researches enabled to define the clinical criteria of disease activity of TSBS and to formulate it's the clinical and morfologic definition and to classify the optimization of diagnostic medical algorithm, adapted to the conditions of domestic medical establishments engaged in the patients with pathology of the hepatobiliary system and its organs help. A new approach was developed to solve scientific problems of patients' treatment having obstructive jaundice complicated by manifestations of multiple organ dysfunctions in the structure of hepato-biliary pathology. This approach uses stage-by-stage tactics of mini-invasive technologies, and involves the comprehensive treatment methods of the extracorporeal detoxification. Based on comparison of instrumental data the role of microbial association endotoxins was examined as one reason of hemodynamic disorders of liver and other organs. Analyzing the data we developed a diagnostic algorithm and choosing criteria methods of conservative and surgical treatment. Methods of detoxification therapy for patients with moderate and heavy over toxic-septic biliary syndrome were improved. Arguments, choice of reasonable methods and terms of surgical interventions were defined, taking into account the nature and extent of biliary obstruction, patients age and presence of concomitant diseases and severity of organ dysfunction. The analysis of the research allowed to develop a classification of toxic - septic biliary syndrome as a cause of organ and multiple organ dysfunction, and allowed to improve methods of biliary sepsis prevention. According to the classification of toxic-septic biliary syndrome an algorithm was developed of staged treatment of patients with toxic-septic biliary syndrome. In this algorithm existing methods of complex surgical treatment of patients were improved with the priority use of mini-invasive technologies and with the involvement of extracorporeal detoxication (plasmapheresis, ultrafiltration). The proposed phasing of patients treatment with biliary toxico-septic syndrome should be considered as a standard modern vision of this problem in order to prevent organ and multiorgan dysfunction. Implementation of the proposed algorithm halved the rate of complications in the immediate and late postoperative period, regardless of the factor obturation especially in patients with elder age group.