EXTRACORPOREAL TECHNOLOGIES IN THE TREATMENT OF CHOLEMIC INTOXICATION IN PATIENTS WITH PURULENT CHOLANGITIS

Аннотация

The frequency of purulent complications of inflammatory diseases of the biliary tract, despite the active attention of researchers to this problem, remains highly relevant. Objective: To improve the results of treatment of patients with biliary sepsis and severe biliary sepsis using an improved method of plasmapheresis. Materials and methods. The study was based on 217 patients with hyperbilirubinemia, acute cholangitis, biliary sepsis and severe benign biliary sepsis complicated by purulent cholangitis. The number of plasmapheresis sessions ranged from 1 to 3. Refusal of plasma reinfusion due to inadequate detoxification was in 3 cases. In other cases, reinfusion provided 85-90% replenishment of the total circulating plasma with autoprotein components at small volumes (600-800 ml) of plasmapheresis. Complications during plasmapheresis sessions were observed in 7 cases and were stopped by adequate therapy. There are no contraindications to transfusion of adequately detoxified autoplasma. Conclusions. Thus, extracorporeal indirect electrochemical oxygenation and the method proposed by us is a highly effective method of preoperative preparation in patients with severe cholemic endotoxicosis against the background of obstructive jaundice, contributing to the stabilization of the activity of the cytolytic and cholestatic process, improving the protein-synthetic function of the liver, which makes it possible to eliminate the main clinical manifestations in patients with this severe contingent of patients, thereby significantly expanding the indications for surgical treatment.