CLINICAL CHARACTERISTICS OF PATIENTS WITH ACUTE CALCULAR CHOLECYSTITIS

Abstract

Currently, scientific research is ongoing aimed at studying the risk factors for unfavorable outcomes of LCEC in ACC, the characteristics of the development of difficult surgical options, and the causes of postoperative complications [1]. According to the results of modern research, both clinical factors, including the duration of the disease, the severity of the inflammatory process and comorbidities, and local morphological changes in the gallbladder affecting its wall, neck, Hartmann's pouch (HP), and surrounding tissues are of decisive importance in the development of an unfavorable course of LCEC [2, 7]. Understanding the mechanisms of the formation of such changes is important for the development of new methods for predicting surgical risk and improving approaches to preventing complications during LCEC [1, 2, 3]. A large number of studies are being conducted worldwide aimed at improving safe LCEC methods, early detection of difficult surgical options, and the prevention of damage to the extrahepatic bile ducts. In their research, V. Casarim et al. [21] studied modern approaches to safe LCEC and the possibilities of preventing severe biliary complications. Liu Y.Q. et al. [23] evaluated the diagnostic efficacy of the Parkland scale in predicting the complexity of LCEC. Hassanesfahani M. et al. [23] analyzed current approaches to assessing the risk of "difficult" LCEC in ACC. Moreira E. et al. [21] studied factors influencing the development of unfavorable surgical outcomes. Harada K. et al. [23], as well as W. You et al. [1,22] investigated the potential of using machine learning methods to predict the complexity of LCEC. The results obtained allowed us to significantly expand our understanding of the mechanisms of complex LCEC and identify the most significant clinical and instrumental risk factors; however, most of the proposed systems are primarily focused on assessing the complexity of the operation or the likelihood of access conversion. A number of scientific studies have also been conducted in Uzbekistan on various aspects of surgical treatment of biliary tract diseases and complicated forms of cholelithiasis. In the works of A.M. Khodjibaev et al. [4,10,11,13], as well as A.G. Mirzakulova et al. [2,3,4,5,14] present the results of improving surgical tactics for biliary pathology. The studies of Sh.I. Karimov et al. [1,4,12,14,17], as well as Kh.A. Akilova et al. [1,5,18,23] are devoted to the issues of diagnostics and treatment of complications of bile duct diseases. In the work of Z.B. Kurbanyiazov et al. [2,20,21,22], S.R. Rasulov et al. [2,6,8,15,16], as well as N.A. Ergashev et al. [1,6,7,19] modern approaches to surgical treatment of complicated forms of cholelithiasis (GSD) are studied. The conducted studies have made a significant contribution to the development of domestic hepatobiliary surgery and improved treatment outcomes for patients with various types of biliary pathology. It should be noted that the presented studies focused on the factors contributing to difficult LCEC, the reasons for access conversion, individual intraoperative complications, and improving the technical aspects of the procedure. However, the patterns of sequential development of adverse LCEC outcomes, which combine clinical, instrumental, and intraoperative changes into a single pathogenetic chain of complications, remain insufficiently studied. Therefore, conducting a comprehensive clinical study aimed at identifying patterns of adverse LCEC outcomes, developing a system for predicting them, and an algorithm for differentiated surgical tactics in ACC is of significant scientific and practical interest.