Mamontov I. Peculiarity of the pathogenesis and treatment of complete and partial obstruction of the extrahepatic biliary tract (experimental clinical research).

Experimental studies has shown that in complete obstruction of the extrahepatic biliary tract , decreasing of the volumetric density of hepatocytes less than 0.6 cm3 / cm3 and the total volume of hepatocytes less than the normal value leads to decompensation and animals death ; partial obstruction is a contributing factor to the cholangitis (p<0.05); partial obstruction of the extrahepatic biliary tract without hyperbilirubinemia leads to increasing of the sinusoidal cells quantity, bile ducts proliferation, decreasing of the volumetric density of hepatocytes, increasing of the total volume of hepatocytes, liver fibrosis; in experimental acute biliary pancreatitis with bile duct obstruction morphological changes of the liver are due only to cholestasis . The clinic study is based on the results of treatment of 576 patients with obstruction of the extrahepatic biliary tract. The factors contributing to the development of cholangitis, acute biliary pancreatitis and Mirizzi's syndrome have been determined. The diagnostic system was developed which allows to confirm or exclude cholangitis urgently with high reliability (≥95%). The score system for ERCP indicating in extrahepatic bile duct obstruction allows to identify patients who need emergency (within 12 hours) or urgent (within 24 hours) endoscopic interventions. The classification of Mirizzi syndrome type II has been improved and a new method of its surgical treatment - cholecystofistulolithotomy - has been developed. The application of the developed diagnostic and therapeutic methods reduces the incidence of moderate and severe forms of cholangitis and/or biliary pancreatitis from 29.1% to 11.9% (p<0.05); reduce open surgery in Mirizzi syndrome from 86.2% to 21.4% (p<0.001); reduce mortality due to cholangitis and/or acute biliary pancreatitis from 10.9% to 4.8%, and overall mortality due to obstruction of the extrahepatic biliary tract - from 2.3% to 1.3%. Key words: complete obstruction of the extrahepatic biliary tract, partial obstruction of the extrahepatic biliary tract, cholangitis, acute biliary pancreatitis, Mirizzi syndrome, ERCP.