DIFFERENTIATED APPROACH TO THE TREATMENT OF PATIENTS WITH ACUTE CHOLANGITIS COMPLICATED BY BILIARY SEPSIS
DOI:
https://doi.org/10.11603/2415-8798.2017.1.7476Keywords:
purulent cholangitis, endogenous intoxication plasmapheresis, indirect electrochemical detoxification plasma.Abstract
Purulent cholangitis is one of the most frequent and severe complications of benign and malignant diseases of the biliary tract.
The aim of the study – the improvement of results of surgical treatment of patients with acute cholangitis differentiated using minimally invasive methods of pre-Biliary decompression and improved method of detoxification – plasmapheresis.
Materials and Methods. The study was conducted on the basis of the clinic of the Samarkand State Medical Institute and included 217 patients with hyperbilirubinemia, acute cholangitis, biliary sepsis and severe biliary sepsis. In 17 patients (I group) we used traditional treatment including infusion and antibiotic therapy; in 18 patients (II group) plasmapheresis was used in combination with indirect electrochemical oxygenation (IECO) plasma sodium hypochlorite; and in 18 (III group) – with additional plasma ozonation (PA with IECO + Ozone) and subsequent reinfusion detoxified plasma.
Results and Discussion. In patients with severe endogenous intoxication, in the postoperative period the most severe endotoxemia, multiple organ failure persisted in patients of group1. In contrast, in patients of the 2 and 3 groups we marked the best surgical results due to the developed diagnostic and treatment algorithm.
Conclusions. The differentiated-stage surgical approach to the implementation of minimally invasive decompression and the use of plasmapheresis allows suppressing of the phenomenon of endotoxemia, cholestasis and liver dysfunction and thereby it improves the outcomes in patients with acute cholangitis.
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