origin. Based on investigation of parameters of hepatosplanchnic blood flow and cholangiomanometry data before and after biliary decompression new pathogenic aspects of development and progression of hepatic failure in mechanical jaundice after biliary decompression is elucidated. For the first time based on study of association between decrease of pressure of bile in biliary ducts and increase of volume blood flow in portal vein it is proved that minimally invasive methods of biliary decompression decrease the risk of development of postdecompression complications due to decrease of liver reperfusion after biliary decompression.
The use of integral severity scores (SAPS II) in mechanical jaundice for determination of surgical tactics is substantiated. The proposed method of monitoring of pressure in bile ducts allow to provide assessment of adequacy of biliary drainage after decompression of biliary ducts. The proposed method of biliary drainage and device for its drainage allow to provide adequate decompression of biliary system and decrease the rate of postoperative complications that contribute improvement of treatment results of patients with mechanical jaundice. It is proved that the use of minimally invasive methods of biliary decompression in mechanical jaundice of benign and malignant etiology allow to achieve the most favorable results of treatment, to decrease the postoperative morbidity and mortality. Advancement of diagnostic and treatment approach in patients with mechanical jaundice allowed to decrease mortality in patients with mechanical jaundice of benign etiology from 4,0% to 1,2% and in patients with mechanical jaundice of malignant etiology from 10,0% to 6,6%.
Key words: mechanical jaundice of benign and malignant etiology, minimally invasive methods of decompression of biliary ducts.
ПЕРЕЛІК УМОВНИХ СКОРОЧЕНЬ
ЕПД – ендоскопічна папілодилятація
ЕПСТ – ендоскопічна папілосфінктеротомія
ЕРПХГ – ендоскопічна ретроградна пакреатікохолангіографія
ЕФГДС – езофагогастродуоденоскопія
ЖВШ – жовчовивідні шляхи
ЖКХ – жовчнокам’яна хвороба
ІОХГ – інтраопераційна холангіографія
КТ – комп’ютерна томографія
ЛЕ – літоекстракція
Лт – літотрипсія
ЛХЕ – лапароскопічна холецистектомія
НКМП – недостатність кукси протоки міхура
ПХЕС – післяхолецистектомічний синдром
УЗД – ультразвукове дослідження
ХЕ – холецистектомія
ЧЧХГ – черезшкірна черезпечінкова холангіографія
ЧЧХД – черезшкірне черезпечінкове холангіодренування
QВВ – об'ємна швидкість кровотоку по воротній| вені
SAPS II – simplified acute physiology score