SURGICAL TACTICS IN PATIENTS WITH ACUTE CHOLECYSTITIS AND POSTINFARCTIC CARDIOSKLEROSIS WITH STENTING OF CORONARY ARTERIES

Abstract

The article the choice and volume of the operative allowance in the treatment of acute cholecystitis against the background of concomitant pathol- ogy of the heart. Taking into account the age of the patients, the comorbid background, the results of cli-nical laboratory and instrumental studies, taking into account the data of ECHO-CG (the indicator of the fraction of ejection from the left ventricle) the optimal strategy must be chosen. The basis for the clinical study were 48 patients with acute cholecystitis who were on inpatient treatment between 2015 and 2017. There were -14 women, 32 men. Patients were divided into study groups, and the comparison group (II) included 24 patients with severe concomitant pathology (bronchial asthma, diabetes, chronic cerebral ischemia, obesity). The main group (I) consisted of 24 patients who had a history of myocardial infarction on a background of hypertension. In determining the tactics of treating patients (efficiency, choice of type of surgery and its volume), we took into account the degree of gallbladder damage, clinical and laboratory data, ECG and ECHO-CG results, and the presence of concomitant Disease (Charlins index). Undoubtedly, considering laparoscopic cholecystectomy as the «gold standard», one should point to a justified alternative in the form of a mini-access operation that minimizes the risk of anesthesia and provides urgent surgical care in general to such a severe group of patients.