International Medical Journal, Vol. 24., Iss. 1, 2018, P. 33−38.
THE CHOICE OF THE VOLUME OF SURGICAL TREATMENT IN PATIENTS WITH DISEASES OF THE COMMON BILE DUCT COMPLICATED BY MECHANICAL JAUNDICE
Kharkiv National Medical University
V. T. Zaitsev Institute of General and Emergency Surgery NAMS of Ukraine
M. E. Zhukovskyi National Aerospace University «Kharkiv Aviation Institute», Ukraine
This article presents an effective, pathogenetically substantiated choice of volume of surgical treatment in patients with diseases of the common bile duct, complicated by mechanical jaundice, using preoperative complex prognosis of the risk of unsatisfactory consequences for each of the possible options for the volume of surgery and the selection of an optimal one. The present study allowed objectifying the choice of the volume of surgical treatment by creating an information model of the disease, which includes the most significant factors that determine it, and determining the optimal method of treatment based on this model. The developed information model included assessment of the patient's condition according to clinical, laboratory, X−ray, endoscopic, ultrasound, helical CT findings, determination of risk factors for complications, and selection of surgical intervention volume. As a risk factor for development of complications, the diagnosis on admission, the level of the biliary block, the duration of mechanical jaundice, the clinical diagnosis at the prehospital stage, the operational risk according to Gologorsky, the presence of cholangitis, the initial level of total serum bilirubin, ultrasound, endoscopy and CT scan were considered the risk factors of complications development. The optimal volume of surgical intervention is selected by providing risk factors for development of complications, ranked by the severity of the coefficients, calculation of the probability of income in a particular group (intervention option) for each of the options for intervention and the selection of the optimal variant by the maximum value of the calculated probability. The presented information model can be used to select an optimal method of surgical treatment for patients with diseases of the common bile duct, complicated obstructive jaundice, before the surgery thus reducing the number of complications and deaths. Decision−making tools allow taking into account previous experience (by comparing with a large database) and reduce the role of the subjective factor. As our practice shows, the information model is effective and pathogenetically substantiated.
Key words: diseases of the common bile duct, mechanical jaundice, choice of volume of surgical treatment, discriminative analysis.