Authors
Fedorov V.E.1, Kharitonov B.S.1, Maslyakov V.V.1, 2, Melsitov V.A.1
1 Saratov State Medical University named after V.I. Razumovsky, Saratov
2 Saratov Medical University “Reaviz”, Saratov
Abstract
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 Railways-Medicine” 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.
Keywords: сholelithiasis, mechanical jaundice, concomitant diseases, endoscopic retrograde cholangiopancreatography, laparoscopic cholecystectomy.
References
1. Merzlikin NV, Podgornov VF, Semichev EV, et al. Methods of treatment of choledocholithiasis. Bulletin of Siberian Medicine. 2015; 14(4): 99-109. (In Russ.) doi: 10.20538/1682-0363-2015-4-99-109.
2. Korolkov AYu, Kitaeva MA, Popov DN, et al. Treatment of cholelithiasis complicated by choledocholithiasis in pregnant women at different gestation periods. Almanac of the A.V. Vishnevsky Institute of Surgery. Moscow. 2019; 2: 57-58. (In Russ.)
3. Bayramlar E.N., Zinatulin D.R., Shevchenko V.P. et al. Mexanik sariqlik bilan murakkablashgan xolangiolitiazni antegrad va antegrad va retrograd jarrohlik davolash usullarining kombinatsiyasidan foydalanish. jarrohlik gepatologiya yilnomalari. 2020; 1: 48-49. (In Russ.) doi: 10.16931/ 1995-5464.2020148-55.
4. Paik KH, Lee YS, Park WS, et al. Clinical Impact of Preoperative Relief of Jaundice Following Endoscopic Retrograde Cholangiopancreatography on Determining Optimal Timing of Laparoscopic Cholecystectomy in Patients with Cholangitis. J. Clin. Med. 2021; 10(19): 4297.
5. Upala S, Sanguankeo A, Jaruvongvanich V. Gallstone Disease and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Observational Studies. Scand. J. Surg. 2017; 106(1): 21-7.
6. Fairfield CJ, Wigmore SJ, Harrison EM. Gallstone Disease and the Risk of Cardiovascular Disease. Sci. Rep. 2019; 9: 5830.
7. Olaiya MT, Chiou HY, Jeng JS, et al. Significantly increased risk of cardiovascular disease among patients with gallstone disease: a population-based cohort study. PLoS One. 2013; 8(10): e76448. doi: 10.1371/journal.pone.0076448.
8. Shabanzadeh DM. Screen-detected gallstone disease and cardiovascular disease. Eur. J. Epidemiol. 2017; 32(6): 501-10.
9. Zheng Y, Xu M, Heianza Y, et al. Gallstone disease and increased risk of mortality: Two large prospective studies in US men and women. Journal of Gastroenterology and Hepatology. 2018; 33(11): 1925- 31.
10. Myshkin KI. Posleoperatsionnaya bolezn’. Endokrinnyye aspekty. Saratov: Izd-vo Sarat. un-ta, 1983. 152 р. (In Russ.)
11. Kaplan MH, Feinstein AR. The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus. Journal Chronic Disease. 1974; 27: 387-404.
12. Charlson ME, Pompei P, Ales HL. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal Chronic Disease. 1987; 40373-383.
13. Miller MD, Towers A. Manual of Guidelines for Scoring the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Pittsburg, Pa: University of Pittsburgh, 1991; 5.
14. Van Weel C, Schellevis FG. Comorbidity and guidelines: conflicting interests. Lancet. 2006; 367: 550-551.
15. Sokolov DA, Kagramanyan MA, Kozlov IA. Estimated hematological indicators for predicting cardiovascular diseases in non-cardiac surgery (pilot study). Bulletin of Anesthesiology and Resuscitation. 2022; 19(2): 14-22. (In Russ.)
16. Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J. Am. Col. Cardiol. 2005; 45: 1638-1643.
17. Martinic-Popovic I, Simundic AM, Dukic L, et al. The association of inflammatory markers with cerebral vasoreactivity and carotid atherosclerosis in transient ischaemic attack. Clinical Biochemistry. 2014; 47(16-17): 182-186.
18. Selye H. The general adaptation syndrome and the diseases of adaptation. J. Clin. Endocrinol. Metab. 1946; 6: 117-230.
19. Sizonenko NA, Surov DA, Solovyov IA, et al. Evolution of the concept of accelerated recovery after surgery: from the origins of the stress theory to its application in emergency surgery (literature review). Surgery. N.I. Pirogov Journal. 2018; 11: 71-79. (In Russ.)
20. Kehlet H. Labat lecture 2005: surgical stress and postoperative outcome from here to where? Reg Anesth Pain Med. 2006; 31(1): 47-52.
21. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery аfter Surgery: a review. JAMA Surg. 2017; 152(3): 292-298.
22. Sumin A.N., Belyalov F.I. Novyye Rossiyskiye rekomendatsii po otsenke i korrektsii serdechno-sosudistykh riskov pri neserdechnykh operatsiyakh. Rossiyskiy kardiologicheskiy zhurnal. 2023; 28(4S): 5704. (In Russ.) doi: 10.15829/1560-4071-2023-5704.
23. Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med. 2015; 373: 2258-69.
24. Gueckel J, Puelacher C, Glarner N, et al. Patient- and procedure-related factors in the pathophysiology of perioperative myocardial infarctioninjury. Int J Cardiol. 2022; 353: 15-21.
25. Cottone S, Vadala L, Guarnery M, et al. Relation of C-reactive protein to oxidative stress and to endothelial dysfunction in essential M. T. hypertension. J. Hypertens. 2005; 23(2); 58.
26. Schiano C, Casamassimi A, Vietri MТ, et al. The roles of mediator complex in cardiovascular diseases Biochimica et Biophysica Acta-Gene Regulatory. Mechanisms. 2014; 1839(6): 444-451.
27. Weiner SD, Ahmed HN, Jin Z, et al. Systemic inflammation and brachial artery endothelial function in the Multi-Ethnic Study of Atherosclerosis (MESA). Heart. 2014; 100(11): 862-866.
28. Hurks R, Vink A, Hoefer IE, et al. Atherosclerotic risk factors and atherosclerotic postoperative events are associated with low inflammation in abdominal aortic aneurysms. Atherosclerosis. 2014; 235(2): 632-641.
