2009-4

.: Дата публікації 2009-12-22 :: Переглядів: 7 :: :.

---

ULTRASONIC METHODS SIGNIFICANCE IN THE BENIGN MECHANICAL JAUNDICE PROGNOSIS
V.P. Kryshen, V.V. Zadorozhniy, N.V. Trofimov, A.A. Polyudov, D.Yu. Ryazanov, N.P. Tykva

The aim – to define the ultrasonic methods value in the non-tumor mechanical jaundice prognosis in postoperative patients.

Materials and methods. 27 patients with benign mechanical jaundice are surveyed. All patients carried out clinical and biochemical researches with an estimation of the immune status on parameters cellular, humoral immunity and cytokines amount. Complex ultrasonic was carried out in dynamics and included research in В-mode. Surgical treatment of patients was conducted with two-stage way. The first stage included papillosphincterotomy, the second – laparoscopic cholecystectomy.

Results and discussion. At patients with MJ syndrome 2nd degree were marked various qualitative – quantitative changes mainly in vessels with the tendency to advent normalization on 2–3 day after operation. At patients with 3rd degree of MJ syndrome the expressed qualitative – quantitative changes mainly are established. To adverse symptoms of current of process are related with decrease in indexes of peripheral resistance Ri and Pi, expressiveness of reversive waves, propulsative type of a curve, and increase of biochemical cytolysis markers. The specified changes appeared for one day earlier than the authentic increase in average blood level of the common bilirubin and biochemical cytolysis markers was appeared. At patients with 4th degree of syndrome MJ were observed the hemodynamic significant qualitative – quantitative changes. At all patients for 2–3 day before occurrence of complications the parameters of the immune status previonsly changed.

Conclusions. Dynamic complex research in the postoperative period allows to establish the cause and to predict the current of MJ. Positive prognostic sign was increase of indexes of peripheral resistance, decrease in intensity of reversive streams and portal-arterial inversion. Decrease in levels Т- and B-lymphocytes characterized heavy current of the postoperative period.