CLINICAL RATIONALE FOR MINIMALE INVAZIVE INTERVENTIONS IN THE TREATMENT OF PATIENTS WITH ACUTE CHOLECYSTITIS WITH A HIGH RISK OF SURGERY AND ANESTHESIA
Keywords:
Acute cholecystitis, comorbidity, diagnosis, sonographic examination, surgical and anesthetic risk, surgical tacticsAbstract
The results of examination and treatment of 341 patients with acute cholecystitis were analyzed. In conditions of the Charlson multimorbidity index (3.20 - 3.31) for acute cholecystitis in elderly and senile patients, the high surgical and anesthetic risk P3, P4 reaches 76.2% (according to the ASA scale) and 69.8% (according to the APACHE scale II), which dictates the priority of minimally invasive interventions at the stages of treatment. The use of minimally invasive puncture-drainage, laparoscopic and endoscopic techniques, taking into account the surgical and anesthetic risk according to ASA, APACHE II and the Charlson comorbidity index, allows for timely completion of the necessary treatment procedures, reducing the number of postoperative complications from 19.7% to 6.4%, postoperative mortality from 6.7% to 1.9%, and also reduce the length of inpatient treatment by an average of 5.5 bed days.
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Статья поступила в редакцию 07.05.2024; одобрена после рецензирования 21.06.2024; принята к публикации 29.06.2024.
The article was submitted 07.05.2024; approved after reviewing 21.06.2024; accepted for publication 29.06.2024.
