Vol. 3, Issue 11 (2017)
A differentiated approach to the treatment of patients with acute cholangitis
Author(s): Azamat Shamsiyev, Salim Davlatov
Abstract: The study was based on the treatment results of 217 patients with mechanical jaundice of benign genesis complicated by purulent cholangitis. In 53 patients with cholemic endotoxicosis after preliminary minimally invasive decompression of the bile ducts various methods of treatment were used. In 17 patients (group I), traditional treatment including infusion and antibiotic therapy was used; in 18 patients (group II) plasmapheresis was used in combination with indirect electrochemical oxygenation (IECO) of plasma with sodium hypochlorite; and in 18 (group III) with additional ozonation of plasma (PA with IECO + Ozone) and subsequent reinfusion of detoxified plasma. Comparative evaluation of the laboratory parameters dynamics in the process of treatment in groups 2 and 3 did not reveal any significant differences. Hyperleukocytosis before operative treatment is noted in both groups. However, after surgical treatment in group 1 patients, the leukocytosis parameters are normalized only at the time of discharge, which indicates more pronounced purulent intoxication. At the same time, in patients of groups 2 and 3 there was a more rapid decrease and normalization of leukocytosis on the 5th postoperative day. The developed differential surgical tactic with the implementation of minimally invasive decompression and the use of plasmapheresis allows to stop the phenomenon of endotoxicosis, cholestasis and liver dysfunction and thereby improve the results of treatment.