Savolyuk S. Reasoning of the treatment policy of patients with obstructive jaundice of nonneoplastic etiology

The thesis is dedicated to the problem of improvement of short- and long-term effects of complex surgery treatment of patients with obstructive jaundice of nonneoplastic etiology. The analysis of 510 operated patients was conducted with evaluation of the results of conservative and operative treatment in early and late postoperative periods. It was defined that unsatisfactory results in the early period are determinedby tactical mistakes due to unreasoned widening of indications for single-stage radical treatment that increases the number of postoperative complications, decreases the level of life in the long-run period - decrease of specific weight in the structure of radical treatment of sphincter destroying and sphincter excluding operations. The creation of prognostic scale of preoperative evaluation of the risk of postoperative complications formed the category of patients with obstructive jaundice of nonneoplastic etiology and determined the indications for single-staged radical correction and staged surgical tactic. The optimization of approaches of differential choice of surgical tactic, diagnostic algorithms and protocols of perioperative support decreased postoperative complications by 10.26%, postdecompressive progression of acute hepatic failure by 9.19% and lethality by 6.4%. The development of clinical profiles of the influence of surgical tactic and methods of postoperative correction for long-run results, algorithms of postoperative rehabilitation and control of its effectiveness was accompanied by the increase of life quality of the operated patients: according to physical component by 48.7%, according to psychological component by 37,48%.