CLINICAL AND LABORATORY CHARACTERISTICS OF THE EFFECTIVENESS OF DIFFERENT METHODS OF SURGICAL INTERVENTION IN PATIENTS WITH COMPLICATED CHOLEDOCHOLITHIASIS

Abstract

The aim of the work: to evaluate clinical and laboratory parameters and the postoperative course in patients with complicated choledocholithiasis undergoing different surgical treatments in order to determine the optimal surgical strategy.
Materials and Methods. The study included a clinical examination and analysis of laboratory data of 122 patients with choledocholithiasis (CHL), complicated by cholangitis (CH) and biliary pancreatitis (BP) in the presence of cholelithiasis (CHL), who were hospitalized in the Ternopil City Communal Hospital of Emergency Care. Patients were divided into 2 groups: 1st (n=59) – patients with choledocholithiasis complicated by cholangitis (CHL+CH), 2nd (n=63) – patients with choledocholithiasis complicated by biliary pancreatitis (CHL+BP). Patients in both groups were divided into subgroups depending on the treatment method. The diagnosis of choledocholithiasis complicated by cholangitis was established based on the clinical protocol “Cholelithiasis (CHL)”, Order of the Ministry of Health of Ukraine No. 271 and Tokyo Guidelines 2018. The diagnosis of biliary pancreatitis was determined according to the Japanese recommendations for the management of biliary pancreatitis. Statistical data processing was performed using the Statistica 10.0 program. Absolute indicators were presented as the mean value (Mean) ± standard deviation (SD), and for non-parametric data – as the median (Me) and quartiles. Pearson’s χ² test was used to compare percentages.
Results. Surgery without contrast administration in patients with CHL+CH or CHL+BP was accompanied by a less pronounced inflammatory response, as confirmed by a significant decrease in body temperature 24 and 72 hours after surgery, as well as a decrease in the intensity of pain syndrome 72 hours after surgery (by 1.42 and 1.26 times, respectively; p<0.05–0.001). In patients with CHL+CH, 24 hours after surgery without contrast, a significantly lower level of L-FABP (by 26.09 %) was determined, and after 72 hours, lower levels of L-FABP (by 36.54 %), ALT (by 53.33 %), and total bilirubin (by 53.50 %) compared to the subgroup with contrast. Similar trends were observed in patients with CHL+BP: 24 and 72 hours after surgery without contrast, the levels of GGT, L-FABP and total bilirubin levels were significantly lower (by 58.84–131.25 %), and after 72 hours, ALT (by 32.61 %) and AST (by 21.62 %) activities decreased further compared to the subgroup with contrast.
Conclusions. Refusal of contrast during surgery is clinically appropriate in patients with choledocholithiasis complicated by cholangitis or biliary pancreatitis, as it contributes to a reduction in inflammatory response, pain syndrome, and improvement in biochemical parameters in the early postoperative period.