PREDICTION OF POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH MECHANICAL JAUNDICE

Mechanical jaundice is the most widespread and severe syndrome of surgical diseases of hepatopancreatobiliary zone. Modern development of surgical technologies allows applying one- or two-stage surgical interventions in this category of patients. Single-stage tactics is characterized by performing a radical surgical intervention, but is associated with a high frequency of postoperative complications and lethality, reaching up to 60 - 70% [9,10]. Two-stage approach is conditioned by drainage of bile ducts and execution of radical surgical intervention after elimination of mechanical jaundice phenomena that takes on the average from 4 to 6 weeks. This approach reduces the frequency of postoperative lethality development up to 30% [16, 19], but increases the frequency of infectious complications development [20] and is associated with the increase of time before the radical operation, which becomes key in patients with mechanical jaundice of tumor origin, because no more than 16% are resectable at the moment of mechanical jaundice manifestation [10]. Thus, correct assessment of hepatic insufficiency and choice of the most rational approach are the key points of patient management. Objective of the study: to improve treatment results of patients with mechanical jaundice. Materials and methods. The examination of 17 patients with mechanical jaundice who were treated in the clinic of general and hospital surgery was carried out. The interrelation between the severity of mechanical jaundice according to E.I. Galperin, hepatic insufficiency determined by the green clearance test in Indocyanine, the state of coagulation link of hemostasis revealed by means of low-frequency piezotromboelastography and development of postoperative complications was assessed. Piezotromboelastography and Indocyanine green clearance test demonstrated a relationship to surgical complications. They are accessible, minimally invasive, promising to be introduced into a broad clinical practice. However, the accumulation of material, its analysis, and systematization of data are required.

low-frequency piezotromboelastography, green clearance test, acute liver failure, mechanical jaundice