Ivanko A. V., Sviridyuk B. V., Khomenko I. P.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Acute cholecystitis is one of the most common acute surgical diseases of the abdominal cavity. Most of these patients are sick elderly. At the moment there is no one views on the tactics of treatment of elderly and senile age with acute cholecystitis complicated by choledocholithiasis. The purpose of research – to improve the results of surgical treatment of elderly and senile patients with acute calculous cholecystitis complicated by choledocholithiasis. Materials and methods. 74 patients were studied elderly with acute cholecystitis, which was complicated by the absence of choledocholithiasis peritonitis. Patient age was 60 years. State of the patients studied on a scale equal ASA – I-II group. Disease duration was less than 3 days. Depending on the method of surgery, all patients were divided into two groups: the first group (control) – 36 patients who underwent one-stage surgery – simultaneously with minimal access cholecystectomy choledocholithotomy, holedoholitoekstraktis and external drainage of the common bile duct; the second group (study group) – 32 patients who underwent one-stage surgery – laparoscopic cholecystectomy simultaneously with holedoholitotekstraktis, external drainage of the common bile duct. Results and consideration of the research. Total number of postoperative complications was observed in the first group – 17 patients (47,2 %) in group II – 7 (21,9 %). The mean hospital stay was a day in the first group 26,2 ± 3,8, the second – 22,7 ± 3,3 days. Average time of surgical treatment of patients in group it was 148,21 ± 13. 8 minutes, II – 132,7 ± 17,4 minutes. Duration of use of analgesics after surgery in patients in I group was 6,3 ± 1,3 days in II group – 3,9 ± 1,2 days. The average duration of medication was in the first group – 9,4 ± 1,5 days, in group II – 6,8 ± 1,2 days. Conclusions. Using simultaneous laparoscopic cholecystectomy choledocholithotomy and external drainage of the common bile duct with acute cholecystitis, which is a complication of choledocholithiasis in elderly and senile age at disease duration is not more than three days and in the absence of peritonitis compared with simultaneous cholecystectomy and minimal access choledocholithotomy, choledoholitoekstraktis reduces: – the number of postoperative complications from 47,2 % to 21,9 %; – postoperative mortality from 11,1 % to 3,1 %; – the duration of drug therapy appointments from 9,4 days to 6,8 days.

acute cholecystitis, choledocholithiasis, advanced age, operation

• Баулина Е. А. Двухэтапная тактика при холецистите как профилактика эндоскопических и эндохирургических ослож- нений / Е. А. Баулина, Г. К. Шокаров, А. А. Баулин [и др.] // Эндоскопическая хирургия. Приложение. Тезисы докладов XVII съезда Российского общества эндоскопических хирургов. – 2014. – № 1. – С. 56-57.
• Бойко В. В. Прогнозування вираженості спайкового процесу у хворих з лапаротоміями в анамнезі при виборі варіанту холецистектомії // В. В. Бойко, А. О. Кулик, А. Д. Вовк [и др.] // Медицина сьогодні і завтра. – 2010. – № 4. – С. 121-124.
• Бобоев Б. Д. Результаты одномоментного лапароскопического лечения больных холецистохоледохолитиазом / Б. Д. Бобоев // Анналы хирургической гепатологии. – 2012. – № 4. – С. 80-85.
• Кононенко С. Н. Диагностика механической желтухи и пути повышения эффективности миниинвазивных технологий, направленнях на ее ликвидацию / С. Н. Кононенко, С. В. Лимончиков // Хирургия. – 2011. – № 9. – С. 4-10.
• Ташкинов Н. В. Пути оптимизации лечения острого холецистита, осложненного холедохолитиазом, у пациентов по- жилого и старческого возраста / Н. В. Ташкинов, Е. В. Николаев, Н. И. Бояринцев [и др.] // Дальневосточный медицин- ский журнал. – 2009. – № 1. – С. 44–46.
• Chiarugi M. Laparoscopic transcystic exploration for single-stage management of common duct stones and acute cholecys- titis / M. Chiarugi, C. Galatioto, L. Decanini [et al.] // Surg. Endosc. – 2012. – № 1. – Р. 124-129.
• Gutt C. N. Acute cholecystitis: primarily conservative or operative approach? / C. N. Gutt // Chirurg. – 2013. – № 3. – Р. 185-190.
• Yun S. S. Better Treatment Strategies for Patients with Acute Cholecystitis and American Society of Anesthesiologists Classification 3 or Greater / S. S. Yun, D. W. Hwang, S. W. Kim [et al.] // Yonsei. Med. J. – 2010. – № 4. – Р. 540-545.
• Zerem E. What is the optimal treatment for acute cholecystitis in elderly patients? / E. Zerem, S. Omerović, Z. Guzin, B. Imširović // Eur. J. Gastroenterol. Hepatol. – 2013. – № 6. – Р. 749.

«Bulletin of problems biology and medicine» Issue 3 part 3 (112), 2014 year, 117-120 pages, index UDK 616. 365-002. 1-089 ± 616. 367-003. 7-06