The dissertation presents a substantiated model of optimization of treatment
of acute hepatopancreatobiliary pathology in obese patients in order to solve the
current scientific problem - improving the results of diagnosis and treatment of this
pathology in obese patients by identifying predictors of severity of the disease,
development of differentiated pathogenically algorithm, also reducing
complications and mortality.
According to the developed program, the research work was carried out in
four stages.
At the preparatory stage, an analysis of informational scientific resources
was carried out in order to study international and domestic experience regarding
the spread of obesity, its role in the pathogenesis of gallstone disease and acute
pancreatitis, as well as known methods of diagnosis and treatment of this
pathology. According to the World Health Organization, obesity is found in 185
million adults in industrialized countries and 115 million in developing countries.
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In Ukraine, 22.1% of the population suffers from obesity. This disease can be
considered a worldwide pandemic of a non-infectious nature. It is known that
obesity is the main factor in the development of cholelithiasis, acute cholecystitis
and pancreatitis. In 20% of patients, acute cholecystitis is combined with obesity.
In addition, obesity is a pro-inflammatory state with an increased level of such proinflammatory cytokines: tumor necrosis factor (TNF-a), interleukins (IL) IL-10,
IL-6, IL-1b. Acute pancreatitis is also a disease whose pathogenesis is based on
cytokine reaction and autolysis. Thus, against the background of an already formed
inflammatory response, the inflammatory reaction is even more intensified and
increased, and the level of pro-inflammatory cytokines reaches critical indicators.
The problem of diagnosis and treatment of patients with acute
hepatopancreatobiliary pathology and obesity is caused by the severe clinical
course of the disease, the increased risk of complications during surgical
interventions, a significant decrease in life expectancy due to the occurrence of
severe concomitant diseases and the high risk of disability of patients of working
age, the appearance of numerous complications that cause an increase in the
mortality rate patients According to the analysis of the literature, the diagnosis of
acute cholecystitis in obese patients with ultrasound examination at the initial stage
of diagnosis is insufficient to monitor the severity of the patient's condition both in
the preoperative period and in the postoperative period. The study of the state of
care for patients with acute pancreatitis and obesity in Ukraine and abroad showed
that the recommendations do not sufficiently take into account the data on the
control of pro-inflammatory cytokines, the aseptic course of the disease and the
timing of infection. Among the international and domestic experience, no
consensus was found regarding the tactics of treatment of acute
hepatopancreatobiliary pathology in obese patients. Solving this problem is the key
to the effectiveness of treatment of acute surgical pathology in obese patients. The
systematic analysis of sources of scientific information provided opportunities for
determining the purpose, tasks, research base, developing a program, choosing
methods, and justifying the scope of the research.
At the first stage of the study, a retrospective analysis of the features of the
course, diagnosis and treatment of acute hepatopancreatobiliary pathology was
carried out. The following groups of patients were selected to fulfill the tasks of the
dissertation:
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- a research group of 571 patients with acute hepatobiliary pathology and
obesity;
- the comparison group consisted of 492 patients with acute hepatobiliary
pathology. The patients of this group had a normal body weight.
The criteria for inclusion in the study were patients with acute hepatobiliary
pathology: patients with acute cholecystitis and patients with acute pancreatitis,
who were initially hospitalized in a hospital. Criteria for not including patients in
the study: chronic cholecystitis or its exacerbation, age less than 18 years, repeated
cases of acute or exacerbation of chronic pancreatitis, absence of the entire range
of studies, obstructive jaundice, including due to oncological pathology, persons
with tumors of the hepatobiliary tract, transitional category overweight patients,
patients with uncompensated chronic diseases.
Patients with acute hepatopancreatobiliary pathology during a retrospective
analysis were further divided according to the diagnosed disease: acute
cholecystitis and acute pancreatitis.
