Terletskyi O. Diagnosis and choice of a minimally invasive treatment technique for oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis

The objects – oligosymptomatic choledocholithiasis in acute calculous cholecystitis; clinical symptoms, diagnosis, expression levels of miRNA molecules in blood and bile, bile microscopy, prognosis, treatment tactics of asymptomatic choledocholithiasis in acute calculous cholecystitis using minimally invasive and open methods, postoperative complications; the purpose – improving the results of diagnosis and treatment of patients with oligosymptomatic choledocholithiasis in acute calculous cholecystitis by improving the diagnostic program for early diagnosis and the method of minimally invasive treatment; methods – general clinical (anamnesis, assessment of the general condition and its severity, questionnaire of long-term results), laboratory tests (general and biochemical analysis of blood, state of the coagulation system, bile microscopy, determination of expression levels of miRNA-122 and miRNA-21), endoscopic examination retrograde cholangiopancreatography), transabdominal ultrasonography of abdominal organs, computed tomography and magnetic resonance imaging of abdominal organs and pancreatobiliary system, statistical processing of research results; results – factors of the increased probability of presence of oligosymptomatic choledocholithiasis on the basis of the anamnesis, clinical course, laboratory data are substantiated. In patients with acute calculous cholecystitis, comparative possibilities of transabdominal ultrasonographic examination, endoscopic retrograde cholangiography and magnetic resonance cholangiography in the diagnosis of small (0.3 - 0.5 cm) concretions of the common bile duct were performed. The role of microcholedocholithiasis in the development of oligosymptomatic disorders of extrahepatic bile ducts has been determined. The significance of expression levels of microRNA-122 and microRNA-21 molecules in blood serum and bile in patients with impaired patency of extrahepatic bile ducts on the background of acute calculous cholecystitis was established. It has been shown that increased serum expression of miRNA-122 and miRNA-21 is likely to be associated with high bile expression levels. The diagnostic algorithm and the choice of minimally invasive surgical treatment of patients with oligosymptomatic choledocholithiasis in acute calculous cholecystitis have been improved; introduced – in the practical work of health care institutions and the scientific and educational process of Danylo Halytsky Lviv National Medical University; branch – health care.