146 research outputs found
Diagnosis and classification of Mirizzi syndrome
Objective. To determine the factors, predisposing to development of Mirizzi syndrome; to improve diagnosis and classification of it, taking into account of these factors and possibilities to apply a definite kind of endoscopic or operative treatment.
Materials and methods. Retrospective analysis was done for results of treatment of 21 patients with Mirizzi syndrome: Type I in accordance to classification of McSherry (1982) was present in 7 patients, while a Type II - in 14.
Results. There was established, that atypia (the variant anatomy) of the ductus cysticus localization predisposes for contact between hepaticocholedochus and a gallbladder of with ductus cysticus, leading to development of Mirizzi syndrome Types I and II. Squeezing (Type I) or fistula (Type II) are observed on any level of hepaticocholedochus. In syndrome of Mirizzi Type II the duct distal to fistula may be not dilated (Subtype IIA) or dilated (Subtype IIB).
Conclusion. Atypia (the variant anatomy) of the ductus cysticus duct constitute a factor, promoting development of Mirizzi syndrome. While diagnostic process for Mirizzi syndrome it is necessary to take into account a localization of squeezing of hepaticocholedochus or of fistula, presence of atypia of the ductus cysticus and its stump localization, character of the gallbladder inflammation, quantity and size of calculi. Proposition to include the Types IIA and IIB II in Mirizzi syndrome, depending on the dilation degree present in hepaticocholedochus distally, to the fistula, constitutes a substantiated principle, because it takes into account a possibility to perform endoscopic lithoextraction and to impact the choice of the surgical treatment method
Diagnostic system of determination of an acute cholangitis
Objecive. To elaborate a diagnostic system, permitting to confirm or exclude the diagnosis of an acute cholangitis in patients, suffering biliary ducts obstruction.
Materials and methods. The wok is based on analysis of clinical, laboratory and instrumental indices in 174 patients, suffering the biliary ducts obstruction (in 18 - with an acute cholangitis).
Results. The diagnostic system was constructed, taking into account informativity of such indices, as ratio of the segmented and stab neutrophils quantity, quantity of stab neutrophils, bilirubin, a gallbladder wall thickness, quantity of monocytes, leukocytes, the Charcotβs triad presence, the body temperature, level of amylase, the duodenal papilla magna size, quantity of lymphocytes, presence of excluded gallbladder, presence of cholecystectomy in anamnesis, the immobile calculus of duodenal papilla magna, tumor, the eosinophils quantity, as well as the presence of any choledocholithiasis and age.
Conclusion. The elaborated diagnostic scheme for determination of an acute cholangitis in patients, suffering biliary ducts obstruction, owes high security (β₯ 95%), because the part of failed diagnosis did not exceeded 5% and have constituted 2.8%
Numerical Investigation of a High-Pressure Gas Medium Preionization by Runaway Electrons
A comparative simulation of the generation and acceleration of runaway electrons in the discharge gap during the initiation of the discharge by nanosecond and subnanosecond pulses is carried out. We used a numerical model based on the PIC-MCC method. Calculations were carried out for N2 6 atm pressure. Numerical simulation of a formation process of the electron avalanche initiated by an electron field-emitted from the top of the cathode micro-spike was carried out taking into account the motion of each electron in the avalanche. Characteristic runaway electron trajectories, runaway electron energy gained during the motion through the discharge gap, times required for runaway electrons to reach the anode were calculated. We compared our results with calculations using well-known differential equation of electron acceleration using braking force in Bethe approximation. We solved this equation also for braking force based on real (experimental) ionization cross section. The reasons for the discrepancy in the calculation results are discussed. Β© 2021 Institute of Physics Publishing. All rights reserved.The work was carried out within the framework of the state tasks of IEP UB RAS and was supported by RFBR, Grant 20-08-00172
Atmospheric Pressure Plasma Generation System Based on Pulsed Volume Discharge for the Biological Decontamination of a Surface
The research introduces a system for pulsed volume discharges ignition at atmospheric pressure within gaps reaching 125βmm. The corona discharge is used for the volume discharge initiation. A damping oscillations pulse generator is used as a high-voltage power supply. The pulse repetition rate reaches 1βkHz, while the rate of damping high-frequency harmonic oscillations can reach megahertz units. The volume discharge electric and spectral characteristics were analyzed. The study revealed that O2+ emission spectrum dominates in the UV region. The potential of using pulsed volume discharge for cleaning biological surfaces was demonstrated in the research. The survival rate for E. coli under the influence of 15βseconds long pulsed volume discharge has decreased by 30βtimes
ΠΠ»ΠΈΡΠ½ΠΈΠ΅ ΡΠ°ΡΡΠΈΡΠ½ΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠΈ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΆΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠ° Π±Π΅Π· Π³ΠΈΠΏΠ΅ΡΠ±ΠΈΠ»ΠΈΡΡΠ±ΠΈΠ½Π΅ΠΌΠΈΠΈ Π½Π° ΠΏΠ΅ΡΠ΅Π½Ρ
Π¦Π΅Π»Ρ. ΠΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π² ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ΅ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΈ Π±ΠΈΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΊΡΠΎΠ²ΠΈ ΠΏΡΠΈ ΡΠ°ΡΡΠΈΡΠ½ΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠΈ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΆΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠ° (Π§ΠΠΠΠ) Π±Π΅Π· Π³ΠΈΠΏΠ΅ΡΠ±ΠΈΠ»ΠΈΡΡΠ±ΠΈΠ½Π΅ΠΌΠΈΠΈ.
ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ° 34 ΠΊΡΡΡΠ°Ρ
ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π»ΠΈ Π§ΠΠΠΠ. ΠΠΈΠ²ΠΎΡΠ½ΡΡ
Π²ΡΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΠΈΠ· ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ° Π½Π° 3, 7, 14, 21, 28-Π΅ ΠΈ 35-Π΅ ΡΡΡΠΊΠΈ. ΠΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ Π±ΠΈΠ»ΠΈΡΡΠ±ΠΈΠ½Π°, Π°Π»ΡΠ±ΡΠΌΠΈΠ½Π°, ΠΌΠΎΡΠ΅Π²ΠΈΠ½Ρ ΡΡΠ²ΠΎΡΠΎΡΠΊΠΈ ΠΊΡΠΎΠ²ΠΈ ΠΈ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π°Π»Π°Π½ΠΈΠ½Π°ΠΌΠΈΠ½ΠΎΡΡΠ°Π½ΡΡΠ΅ΡΠ°Π·Ρ (ΠΠΠ’), Π°ΡΠΏΠ°ΡΡΠ°ΡΠ°ΠΌΠΈΠ½ΠΎΡΡΠ°Π½ΡΡΠ΅ΡΠ°Π·Ρ (ΠΠ‘Π’), ΡΠ΅Π»ΠΎΡΠ½ΠΎΠΉ ΡΠΎΡΡΠ°ΡΠ°Π·Ρ (Π©Π€). ΠΠ·ΠΌΠ΅ΡΡΠ»ΠΈ Π΄ΠΈΠ°ΠΌΠ΅ΡΡ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΆΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠ°, ΠΌΠ°ΡΡΡ ΠΈ ΠΎΠ±ΡΠ΅ΠΌ ΠΏΠ΅ΡΠ΅Π½ΠΈ, ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π»ΠΈ Π΅Π΅ Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡ, Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΠΌΠΎΡΡΠΎΠΌΠ΅ΡΡΠΈΡ. ΠΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ ΡΠ»ΡΠΆΠΈΠ»ΠΈ 17 ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π£ 14 (41,2%) ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈ Π§ΠΠΠΠ Π±Π΅Π· Π³ΠΈΠΏΠ΅ΡΠ±ΠΈΠ»ΠΈΡΡΠ±ΠΈΠ½Π΅ΠΌΠΈΠΈ. ΠΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΡΠ΅ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΎΡΠΌΠ΅ΡΠ΅Π½Ρ Π½Π° 28 β 35-Π΅ ΡΡΡΠΊΠΈ: ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΠΌΠ°ΡΡΡ ΠΏΠ΅ΡΠ΅Π½ΠΈ Π½Π° 31% ΠΈ Π΅Π΅ ΠΎΠ±ΡΠ΅ΠΌΠ° Π½Π° 25,5%; ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΠΈΡΠ»Π° ΠΈ Π΄ΠΈΠ»Π°ΡΠ°ΡΠΈΡ ΠΆΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΠΎΡΠΎΠΊΠΎΠ², ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΠΈΡΠ»Π° ΡΠΈΠ½ΡΡΠΎΠΈΠ΄Π°Π»ΡΠ½ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ, ΠΏΠ»ΠΎΡΠ°Π΄ΠΈ Π³Π΅ΠΏΠ°ΡΠΎΡΠΈΡΠΎΠ², Π½Π°Π»ΠΈΡΠΈΠ΅ ΡΠΈΠ±ΡΠΎΠ·Π° ΠΠ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π² 4 ΠΈΠ· 5 Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΉ. ΠΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π±ΠΈΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ Π±ΡΠ»ΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΠΌΠΈ ΡΠΎΠ»ΡΠΊΠΎ Π½Π° 3 β 7-Π΅ ΡΡΡΠΊΠΈ: ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ Π°Π»ΡΠ±ΡΠΌΠΈΠ½Π° ΡΠ½ΠΈΠ·ΠΈΠ»ΠΎΡΡ Π΄ΠΎ (21,6 Β± 2,5) Π³/Π», ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ β (26,7 Β± 1,6) Π³/Π». Π ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ° Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΠΠ’, ΠΠ‘Π’, Π©Π€, ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ ΠΌΠΎΡΠ΅Π²ΠΈΠ½Ρ Π½Π΅ ΠΎΡΠ»ΠΈΡΠ°Π»ΠΈΡΡ ΠΎΡ ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΡΡ
Π²Π΅Π»ΠΈΡΠΈΠ½.
ΠΡΠ²ΠΎΠ΄Ρ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΏΠΎΠ»Π½ΡΡ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΡ, Π§ΠΠΠΠ Π±Π΅Π· Π³ΠΈΠΏΠ΅ΡΠ±ΠΈΠ»ΠΈΡΡΠ±ΠΈΠ½Π΅ΠΌΠΈΠΈ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ Π·Π½Π°ΡΠΈΠΌΡΠΌ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌ ΠΏΠ΅ΡΠ΅Π½ΠΈ
ΠΠΠ Π€ΠΠΠΠΠΠ§ΠΠ‘ΠΠΠ ΠΠΠΠΠΠΠΠΠ― ΠΠΠ§ΠΠΠ ΠΠ Π ΠΠΠ‘ΠΠΠ ΠΠΠΠΠ’ΠΠΠ¬ΠΠΠ ΠΠ‘Π’Π ΠΠ ΠΠΠΠΠΠ ΠΠΠ ΠΠΠΠΠ ΠΠΠ’ΠΠ’Π
Π£ ΠΊΡΡΡ Π»ΠΈΠ½ΠΈΠΈ ΠΠΈΡΡΠ°Ρ ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π»ΠΈ Ρ
ΠΎΠ»Π΅ΡΡΠ°Π· ΠΏΡΡΠ΅ΠΌ ΠΏΠ΅ΡΠ΅Π²ΡΠ·ΠΊΠΈ ΠΎΠ±ΡΠ΅Π³ΠΎ ΠΆΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠ° (ΠΠΠ), ΠΎΡΡΡΡΠΉ Π±ΠΈΠ»ΠΈΠ°ΡΠ½ΡΠΉ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡ (ΠΠΠ) - Π½ΠΈΠ·ΠΊΠΎΠΉ ΠΏΠ΅ΡΠ΅Π²ΡΠ·ΠΊΠΈ Π±ΠΈΠ»ΠΈΠΎΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΡΠΎΡΠΎΠΊΠ°. ΠΠ±ΡΠ°Π·ΡΡ ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π»ΠΈ ΡΠ΅ΡΠ΅Π· 1, 3, 7 ΡΡΡ. ΠΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, Ρ ΠΊΡΡΡ ΠΎΠ±Π΅ΠΈΡ
Π³ΡΡΠΏΠΏ Π²ΡΡΠ²Π»Π΅Π½Ρ ΠΎΡΠ°Π³ΠΈ Π½Π΅ΠΊΡΠΎΠ·Π° Π³Π΅ΠΏΠ°ΡΠΎΡΠΈΡΠΎΠ², ΠΈΡ
Π³ΠΈΠΏΠ΅ΡΡΡΠΎΡΠΈΡ Ρ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΈΡΠΎΠΏΠ»Π°Π·ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΡ (Π―Π¦Π), ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΠΎΠ±ΡΠ΅ΠΌΠ½ΠΎΠΉ ΠΏΠ»ΠΎΡΠ½ΠΎΡΡΠΈ (Vv) Π²ΠΎΡΠΎΡΠ½ΡΡ
ΠΊΠ°Π½Π°Π»ΠΎΠ², ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΠΆΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΠΎΡΠΎΠΊΠΎΠ², ΡΠΈΠ½ΡΡΠΎΠΈΠ΄Π½ΡΡ
ΠΊΠ»Π΅ΡΠΎΠΊ. ΠΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² ΠΏΠ΅ΡΠ΅Π½ΠΈ ΠΏΡΠΈ ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΠΎΠΌ ΠΠΠ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΠ²ΠΈΡΠΌΠΈ Ρ
ΠΎΠ»Π΅ΡΡΠ°Π·Π°, ΠΎΠ½ΠΈ Π²ΠΎΠ·Π½ΠΈΠΊΠ°Π»ΠΈ ΡΠ°Π½ΡΡΠ΅ ΠΈ Π±ΡΠ»ΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Ρ ΠΏΡΠΈ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠ²Π½ΠΎΠΌ Ρ
ΠΎΠ»Π΅ΡΡΠ°Π·Π΅ (ΠΠ₯)
The results of treatment of patients with an acute cholecystitis and perivesical complications
Objective. To improve the quality of diagnosis and results of treatment in patients, suffering an acute cholecystitis, complicated by formation of perivesicular infiltrate, abscess and Mirizziβs syndrome.
Materials and methods. Results of diagnosis and surgical treatment of 694 patients, suffering an acute cholecystitis, ageing 38 - 87 yrs old, admitted to the clinic in 2010 - 2019 yrs, were analyzed. The examination have included general clinical investigation, biochemical investigations of the blood, ultrasonographic investigation of a gallbladder and extrahepatic biliary ducts, and in accordance to certain indications β computer tomography, papilloscopy and endoscopic retrograde cholangiopancreaticography.
Results. Of 694 patients, suffering an acute cholecystitis in 541 (78.0%) perivesical complications were revealed. In 215 (31.0%) patients perivesical infiltrate was formed, while in 76 (11.0%) β perivesical abscess. In 250 (36.0%) patients an acute cholecystitis have developed on background of obturation jaundice, caused by choledocholithiasis in 138 patients, while in 98 patients Mirizziβs syndrome Type I was diagnosed, and in 14 - Mirizziβs syndrome Type II. Of 215 patients with an acute cholecystitis and perivesical infiltrate in 84 laparoscopic cholecystectomy was performed after course of antibacterial therapy, while in 131 patients β open cholecystectomy. In all 76 patients with perivesical abscess open cholecystectomy was performed. Of 138 patients, suffering obturation jaundice on background of choledocholithiasis in 82 endoscopic retrograde cholangiopancreaticography with simultaneous lithoextraction and subsequent laparoscopic cholecystectomy was conducted. In 56 patients naso-biliary drainage was installed and was held in place till calculi from common biliary duct have gone away and subsequent laparoscopic cholecystectomy performed. Of 98 patients with an acute cholecystitis and confirmed Mirizziβs syndrome Type I in 95 laparoscopic cholecystectomy was performed, while in 3 β the open one. Of 14 patients, suffering Mirizziβs syndrome Type II, in 10 open operation was done with sanation of biliary ducts and plasty of a common biliary duct defect, while in 4 β laparoscopic cholecystocholedocholithotomy with restoration of the bile physiological passage.
Conclusion. In 78.0% patients with an acute cholecystitis perivesical complications were diagnosed. Of 531 patients with perivesical infiltrate, choledocholithiasis and Mirizziβs syndrome in 321 (60.5%) laparoscopic operations on biliary ducts were accomplished. Open laparotomy was performed in 210 (39.5%) patients. In all the patients, suffering Mirizziβs syndrome of both Types, physiologic passage of bile was preserved
The risk factors for development of an acute biliary pancreatitis and its signs in obstruction of extrahepaic bilairy ducts
Objective. A search for factors, promoting development of an acute biliary pancreatitis, and peculiarities of its signs in patients, suffering obstruction of extrahepatic biliary ducts.
Materials and methods. Retrospective analysis of treatment in 283 patients, suffering obstruction of extrahepaic biliary ducts, was conducted, together with various indices analysis in patients, suffering an acute biliary pancreatitis and without acute biliary pancreatitis.
Results. An acute biliary pancreatitis was diagnosed in 30 (10.6%) patients. Trustworthy differences (p < 0.05) were revealed, concerning pronounced pain syndrome, hyperthermia, leukocytosis, young neutrophils, general bilirubin, amylase in the blood, the gallbladder volume, choledocholithiasis, the fixed calculus and stenosis of duodenal papilla magna, cholangitis. Big calculi of hepaticocholedochus did not associated with development of an acute biliary pancreatitis, and a sludge in common biliary duct and stenosis of duodenal papilla magna were characteristic for an acute biliary pancreatitis (p < 0.001).
Conclusion. Sludge of common biliary duct, stenosis and fixed calculus of duodenal papilla magna, bilirubinemia 70 mcmol/l and higher constitute the risk factors for development of an acute biliary pancreatitis, and the pronounced abdominal pain syndrome, hyperthermia, hyperamylasemia, leucocytosis, increase of the young neutrophils content up to 7% and higher, the volume ofΒ a gallbladder 50 cm3 and more - served as the signs of an acute biliary pancreatitis in obstruction of extrahepatic biliary ducts. In obstruction of extrahepatic biliary ducts with an acute biliary pancreatitis, comparing with obstruction of extrahepatic biliary ducts without an acute biliary pancreatitis, cholangitis is revealed trustworthily: 16.7 and 5.1% accordingly (p < 0.05)
Π€Π°ΠΊΡΠΎΡΡ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΡ ΠΎΡΡΡΠΎΠ³ΠΎ Ρ ΠΎΠ»Π°Π½Π³ΠΈΡΠ° Ρ Π±ΠΎΠ»ΡΠ½ΡΡ Ρ Π΄ΠΎΠ±ΡΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠ΅ΠΉ Π²Π½Π΅ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΡ ΠΆΠ΅Π»ΡΠ½ΡΡ ΠΏΡΡΠ΅ΠΉ
Π¦Π΅Π»Ρ. ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΡΠ°ΠΊΡΠΎΡΠΎΠ², ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΡΡΠΈΡ
ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΎΡΡΡΠΎΠ³ΠΎ Ρ
ΠΎΠ»Π°Π½Π³ΠΈΡΠ° (ΠΠ₯) ΠΈΠ»ΠΈ ΡΠ²Π»ΡΡΡΠΈΡ
ΡΡ Π΅Π³ΠΎ ΠΏΡΠΈΠ·Π½Π°ΠΊΠ°ΠΌΠΈ ΠΏΡΠΈ Π΄ΠΎΠ±ΡΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠΈ Π²Π½Π΅ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΡΡ
ΠΆΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΡΠ΅ΠΉ (ΠΠΠΠΠ).
ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π Π΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ 144 Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ ΠΠΠΠΠ, ΠΠ₯ ΠΎΡΠΌΠ΅ΡΠ΅Π½ Π² 17 Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡΡ
. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΠ΅ Π²ΡΡΡΠ΅ΡΠ°Π΅ΠΌΠΎΡΡΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΠΈ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΠ₯ ΠΈ Π±Π΅Π· ΠΠ₯.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π Π°Π·Π»ΠΈΡΠΈΡ Π²ΡΡΠ²Π»Π΅Π½Ρ (p 0,05) ΠΌΠ΅ΠΆΠ΄Ρ ΡΠ»Π΅Π΄ΡΡΡΠΈΠΌΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ: ΠΏΠΎΠ», Π²ΠΎΠ·ΡΠ°ΡΡ, ΠΈΠ½Π΄Π΅ΠΊΡ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π°, Π½Π°Π»ΠΈΡΠΈΠ΅ Π°Π±Π΄ΠΎΠΌΠΈΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ Π±ΠΎΠ»Π΅Π²ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°, Ρ
ΠΎΠ»Π΅ΡΠΈΡΡΡΠΊΡΠΎΠΌΠΈΡ Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅, ΠΎΠ±ΡΠ΅ΠΌ ΠΠ, ΠΏΡΠΈΡΠΈΠ½Π° ΠΎΠ±ΡΡΡΡΠΊΡΠΈΠΈ, ΡΠ°ΡΡΠΈΡΠ΅Π½ΠΈΠ΅ Π³Π΅ΠΏΠ°ΡΠΈΠΊΠΎΡ
ΠΎΠ»Π΅Π΄ΠΎΡ
Π°, ΡΠ½Π΄ΠΎΡΠΊΠΎΠΏΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΏΠ°ΠΏΠΈΠ»Π»ΠΎΡΡΠΈΠ½ΠΊΡΠ΅ΡΠΎΡΠΎΠΌΠΈΡ Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅, Π½Π°Π»ΠΈΡΠΈΠ΅ ΠΎΠΊΠΎΠ»ΠΎΡΠΎΡΠΎΡΠΊΠΎΠ²ΠΎΠ³ΠΎ Π΄ΠΈΠ²Π΅ΡΡΠΈΠΊΡΠ»Π° ΠΈ ΠΎΡΡΡΠΎΠ³ΠΎ Π±ΠΈΠ»ΠΈΠ°ΡΠ½ΠΎΠ³ΠΎ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ°.
ΠΡΠ²ΠΎΠ΄Ρ. Π€Π°ΠΊΡΠΎΡΡ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ₯: ΡΡΠΎΠ²Π΅Π½Ρ ΠΎΠ±ΡΠ΅Π³ΠΎ Π±ΠΈΠ»ΠΈΡΡΠ±ΠΈΠ½Π° 70 ΠΌΠΊΠΌΠΎΠ»Ρ/Π» ΠΈ Π²ΡΡΠ΅, ΡΡΠΎΠ»ΡΠ΅Π½ΠΈΠ΅ ΡΡΠ΅Π½ΠΊΠΈ ΠΠ Π΄ΠΎ 4 ΠΌΠΌ ΠΈ Π±ΠΎΠ»Π΅Π΅, ΠΎΡΠΊΠ»ΡΡΠ΅Π½Π½ΡΠΉ ΠΠ, ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ ΠΊΠ°ΠΌΠ΅Π½Ρ ΠΠ‘ΠΠΠ, ΡΠ°Π·ΠΌΠ΅Ρ ΠΠ‘ΠΠΠ 15 ΠΌΠΌ ΠΈ Π±ΠΎΠ»Π΅Π΅. ΠΡΠΎΡΠ²Π»Π΅Π½ΠΈΡ ΠΠ₯: Π³ΠΈΠΏΠ΅ΡΡΠ΅ΡΠΌΠΈΡ, Π½Π°Π»ΠΈΡΠΈΠ΅ ΡΡΠΈΠ°Π΄Ρ Π¨Π°ΡΠΊΠΎ, Π»Π΅ΠΉΠΊΠΎΡΠΈΡΠΎΠ· 9 Γ 109 Π² 1 Π» ΠΈ Π²ΡΡΠ΅, ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΠΎΠ΄Π΅ΡΠΆΠ°Π½ΠΈΡ ΠΏΠ°Π»ΠΎΡΠΊΠΎΡΠ΄Π΅ΡΠ½ΡΡ
Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² Π΄ΠΎ 7% ΠΈ Π²ΡΡΠ΅, Π³ΠΈΠΏΠ΅ΡΠ°ΠΌΠΈΠ»Π°Π·Π΅ΠΌΠΈΡ
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