pirogovestnikВестник Национального медико-хирургического центра им. Н.И. ПироговаBulletin of Pirogov National Medical & Surgical Center2072-82552782-3628Национальный медико-хирургический Центр им. Н.И. Пирогова10.25881/20728255_2026_21_2_63pirogovestnik-596Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESРАЗВИТИЕ ДЕКОМПЕНСАЦИИ СОПУТСТВУЮЩИХ ЗАБОЛЕВАНИЙ ПРИ ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ КАЛЬКУЛЕЗНОГО ХОЛЕЦИСТИТА, ОСЛОЖНЕННОГО МЕХАНИЧЕСКОЙ ЖЕЛТУХОЙDEVELOPMENT OF DECOMPENSATION OF CONCOMITANT DISEASES IN CALCULOUS CHOLECYSTITIS COMPLICATED BY OBSTRUCTIVE JAUNDICE AND ITS SURGICAL TREATMENTФедоровВ. Э.FedorovV. E.

Саратов

Saratov

ХаритоновБ. С.KharitonovB. S.

Саратов

Saratov

МасляковВ. В.MaslyakovV. V.

Саратов

Saratov

maslyakov@inbox.ruМельситовВ. А.MelsitovV. A.

Саратов

Saratov

ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского»РоссияSaratov State Medical University named after V.I. RazumovskyRussian FederationФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского»; Саратовский медицинский университет «Реавиз»РоссияSaratov State Medical University named after V.I. Razumovsky; Saratov Medical University “Reaviz”Russian Federation2026100620262126367Copyright © Федоров В.Э., Харитонов Б.С., Масляков В.В., Мельситов В.А., 20262026Федоров В.Э., Харитонов Б.С., Масляков В.В., Мельситов В.А.Fedorov V.E., Kharitonov B.S., Maslyakov V.V., Melsitov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://submit.pirogov-vestnik.ru/jour/article/view/596

Цель работы. Исследовать особенности развития декомпенсации сопутствующих заболеваний при осложнениях калькулезного холецистита, сопровождающегося механической желтухой, в периоперационном периоде. Материал и методы. Проанализированы данные 60 больных неопухолевой механической желтухой, лечившихся в хирургическом отделении ЧУЗ КБ «РЖД–Медицина» г. Саратова. У них диагностированы различные осложнения холецистохоледохолитиаза: стриктуры желчных протоков, панкреатиты, резидуальный холедохолитиаз и синдром Мириззи. Наиболее частым сопутствующим заболеванием являлся генерализованный атеросклероз – 42 (70,0%) случая, артериальная гипертония – 25 (41,7%); ИБС – 17 (28,3%), ожирение – 11 (18,3%), хроническая ишемия мозговых сосудов – 8 (13,3%), сахарный диабет – 5 (8,3%). Всем больным производилась малотравматичная билиарная декомпрессия желчных путей, затем 55 пациентам выполнена лапароскопическая холецистэктомия. В периоперационном периоде определялся уровни общего и прямого билирубина, щелочной фосфатазы, АСЛ, АЛТ, лейкоцитоза, ЦИК и МСМ крови, исследовались шкалы коморбидности (CIRS, Kaplan-Fenstein, Charlson), а также предикторы активации эндотелиальной дисфункции (ИЛ-6, ИЛ-8, СРБ) и ишемии миокарда (уровни в плазме тропонина и NTproNBB). Результаты. Пики данных изменений наблюдались до, после билиарной декомпрессии и лапароскопической холецистэктомии. Выводы: развитие осложнений желчнокаменной болезни, сопровождающихся механической желтухой, приводит к прогрессированию эндотелиальной дисфункции с развитием ишемии органов и тканей. Это обуславливает возникновение синдрома взаимного отягощения, который усиливается при эндохирургической травме. Уровень в крови маркеров эндотелиальной дисфунции и ишемии миокарда у таких пациентов может рассматриваться как фактор прогноза возникающих изменений и послеоперационных осложнений.

The objectiv was characteristics of the path of development of the complication of concomitant diseases with calculous cholecystitis with obstructive jaundice. Materials and methods. The data of 60 patients with non–cancerous mechanical jaundice who were admitted to the surgical department of the CHUZ KB “Russian RailwaysMedicine” in Saratov were analyzed. They had various complications of cholecystocholedocholithiasis: strictures of the bile ducts, pancreatitis, residual choledocholithiasis, and Mirizzi syndrome. The most common concomitant disease was generalized atherosclerosis in 42 (70,0%) cases, followed by hypertension in 25 (41,7%), coronary artery disease in 17 (28,3%), obesity in 11 (18,3%), chronic cerebral ischemia in 8 (13,3%), and diabetes mellitus in 5 (8,3%). In addition to determining the blood levels of total and direct bilirubin, alkaline phosphatase, ASL, ALT, leukocytosis, and the amount of CEC and MSM in the blood of hospitalized patients, comorbidity scales (CIRS, Kaplan-Fenstein, Charlson), as well as indicators of activation of endothelial dysfunction (IL-6, IL-8, CRP) and ischemia were studied. myocardium (blood levels of troponin and NTproNBB). All patients underwent minor traumatic biliary decompression of the biliary tract, followed by laparoscopic cholecystectomy. Results. In patients with non-cancerous breast cancer, a significant reaction of markers of endothelial dysfunction and myocardial ischemia was revealed in the form of an increase in their plasma content. In the perioperative period, it increased both after ERCP and after laparoscopic cholecystectomy. These markers correlated with each other and with the severity of jaundice. Conclusions. the development of GI complications leads to the progression of endothelial dysfunction with the development of ischemia of organs and tissues. This causes the occurrence of a syndrome of mutual aggravation, which increases with endosurgical trauma. The blood levels of markers of endothelial dysfunction and myocardial ischemia in such patients can be considered, as a predictor of emerging changes and postoperative complications of an organ and systemic nature.

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The authors declare that there are no conflicts of interest present.