DIAGNOSIS OF ACUTE DESTRUCTIVE CHOLECYSTITIS IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERY IN REGIONAL HOSPITALS

Аннотация

Acute cholecystitis is one of the most common diseases of the abdominal cavity. Materials and methods. The study material was the medical records of 77 patients operated on in the Khankinsky district hospital in 2023 for acute cholecystitis within 72 hours of the onset of the disease. Results and discussion. Our univariate analysis of variance allowed us to establish that there is a significant difference in average values between the groups of patients with catarrhal and destructive acute cholecystitis according to a number of studied indicators, which allows them to be used as prognostic factors for the detection of acute destructive cholecystitis. Conclusion. In order to timely resolve the issue of urgent laparoscopic cholecystectomy in a regional hospital, the diagnosis of acute destructive cholecystitis with a high degree of reliability can be established by identifying a combinationof clinical, ultrasound signs andchanges infunctional liver tests. Keywords: acute destructive cholecystitis; laparoscopic surgery; cholecystectomy; functional livertests. Introduction. Acute cholecystitis is one of the most common diseases of the abdominal cavity. In the last two decades, significant progress has been made in the diagnosis and improvement of its treatment methods, which has significantly reduced the rates of postoperativecomplications and mortality in this pathology [1-6]. Cholecystectomy is a radical intervention leading to a complete recovery of the patient. Laparoscopic cholecystectomy is one of the minimally invasive and effective surgical interventions for acute destructive cholecystitis. Performing laparoscopic cholecystectomy at an early stage makes it a relatively safe and affordable intervention, which provides an additional advantage in the form of shorter hospital stays. To reduce the number of conversions, laparoscopic cholecystectomy is most appropriate within 72-96 hours of the onset of the attack [7-9]. However, early diagnosis of acute destructive cholecystitis often causes difficulties, because the available clinical, laboratory and instrumental data do not always allow us to exclude or confirm the presence of destructive changes in the gallbladder wall. Accordingly, the purpose of our study was to study the effectiveness of the main methodsused inthe diagnosisof acutecholecystitis in regional hospitals. Materials and methods. The studymaterial was the medical records of 77 patients operated on inthe Khanka district hospital in 2023 for acute cholecystitis within 72 hours of the onset of the disease. All patients were divided into two groups: the first group with acute cholecystitis without signs of destruction – 35 people; the second with acute destructive cholecystitis – in the presence of phlegmonous and gangrenous changes according to the results ofmorphological examinationof preparations ofremoved gallbladders -42people. Medical history data, clinical examination results, general and biochemical blood tests, and ultrasound examinationswere used. 98,7:ROTCAFTCAPMI.SECNEICS LACIDEM,5202, yraurbeF,5emuloV gro.srehsilbupcimedaca.www Patients with ASA III or IV surgical risk, over the age of 70, with a history of upper abdominal surgery, and pregnant women were not included in the study. For quantitative normally distributed features, statistical reliability was assessed using the Student's criterion (t). Nonparametric criteria were used for a different distribution of features from the normal one. The differences were considered significant with an error probability of P<0.05. One- factor analysis of variance was used to identify the significance of the established prognostic factors. To calculate the diagnostically significant levels, we used the definition of reference intervals using a central range covering 95% of the data values [10]. The obtained research results were processed using theSTATISTICA 6.0software package. Results and discussion. Our univariate analysis of variance allowed us to establish that there is a significant difference in average values between the groups of patients with catarrhal and destructive acute cholecystitis according to a number of studied indicators, which allows them to be used as prognostic factors for the detection of acute destructive cholecystitis. For each of the identified prognostic factors of acute destructive cholecystitis, the following were calculated: the point of a diagnostically significant level (Cut-off point), sensitivity (Se), specificity (Sp), the prognostic value of a positive (+PV) and negative result (-PV), accuracy (diagnostic effectiveness). Traditionally, the diagnosis of acute destructive cholecystitis is made on the basis of a set of data from clinical, laboratory and instrumental research methods. The established prognostic factors were grouped, respectively, into the clinical diagnosis of acute destructive cholecystitis, ultrasound diagnosis of acute destructive cholecystitis,and functional liver test(Table 1). Table1 The