RESUMO
Abstract The results of surgical treatment of 184 patients for obturation jaundice, caused by choledocholithiasis, were analyzed. Morphological changes of the liver were studied in 20 patients. There were three groups of patients delineated, depending on the obturation jaundice duration: up to 7 days, from 8 to 14 days, more than 15 days, and also a group of patients after the bile outflow restoration. The obturation jaundice occurrence in choledocholithiasis is accompanied by significant morphological changes in the liver, severity of which is enhancing while the obturation jaundice persistence increasing. While persistence of obturation jaundice through 8 days and more the connective tissue volume is enhancing, a relative volume of hepatocytes is reducing and a stromal-parenchymatous index is increasing. The bile outflow restoration secures significant reduction of intensity of alterative and inflammatory changes in hepatic parenchyma, as well as activation of reparative processes in the tissue. In cholangitis, caused by P. aeruginosa and E. coli, according to morphological investigations data, in the liver a diffuse purulent cholangitis on background of chronic changes in accordance to duration of the obturation jaundice persists.
Assuntos
Colangite/patologia , Coledocolitíase/patologia , Hepatócitos/patologia , Icterícia Obstrutiva/patologia , Fígado/patologia , Bile/metabolismo , Bile/microbiologia , Colangite/etiologia , Colangite/microbiologia , Colangite/cirurgia , Coledocolitíase/complicações , Coledocolitíase/microbiologia , Coledocolitíase/cirurgia , Ducto Colédoco/microbiologia , Ducto Colédoco/patologia , Ducto Colédoco/cirurgia , Escherichia coli/crescimento & desenvolvimento , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Infecções por Escherichia coli/cirurgia , Feminino , Hepatócitos/microbiologia , Humanos , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/microbiologia , Icterícia Obstrutiva/cirurgia , Fígado/microbiologia , Fígado/cirurgia , Masculino , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/patologia , Infecções por Pseudomonas/cirurgia , Pseudomonas aeruginosa/crescimento & desenvolvimento , Fatores de TempoRESUMO
The results of surgical treatment of 184 patients for obstructive jaundice and an acute cholangitis in choledocholithiasis were analyzed. Acute cholangitis was diagnosed in 62 (33.7%) patients. Sensitivity of a Tokyo Guidelines (2013)--TG 13 criteria for diagnosis and estimation of the course severity of an acute cholangitis was studied. Dynamics of postoperative laboratory parameters was studied. There was established, that occurrence of obturation jaundice and cholangitis coincides with pronounced hepatic function disorders, which are preserved after a bile outflow restoration also, and changes in peripheral blood. Severity of inflammatory reaction reflects hematological indices, the most informative of which is an intoxication index.
