INCIDENCE OF COMPLICATED FORMS OF CHOLELITHIASIS

Background. Recently, there has been noted a steady increase in the incidence of cholelithiasis and its complicated forms. A study of the morbidity pattern of various forms of cholelithiasis will allow optimization and improvement of the quality of delivery of medical care to patients with cholelithiasis. Aim to study the epidemiology of various forms of cholelithiasis on an example of Ryazan district. Materials and methods. In the work the final reports of the surgeon-in-chief of Ryazan district and of the leading clinics of Ryazan for the recent 6 years were used, on which basis a statistical analysis of the incidence of various forms of cholelithiasis was carried out. Results. From 2011 to 2016, 15396 patients with various forms of cholelithiasis underwent treatment in the medical institutions of Ryazan district. Of these, 2052 patients (13.3%) had choledocholithiasis, in 1182 of them (57.6%) choledocholithiasis was complicated with stenotic duodenal papillitis. In 1641 cases (79.9%) the disease was complicated with mechanical jaundice. The most common surgery for cholelithiasis is laparoscopic cholecystectomy which makes 89.1% of the total amount of cholecystectomies. About 433 surgical interventions and 1608 endoscopic papillotomies were performed in connection with choledocholithiasis. Choledocholithotomy accounted for 47.1% of all interventions, choledochoduodenostomy – for 42.9%. Laparoscopic choledocholithotomy accounted for 10% of the total choledocholithotomies, with its share increasing every year. The main causes of death in patients with complicated forms of cholelithiasis were mechanical jaundice with purulent cholangitis and with subsequent development of hepatorenal insufficiency, cholangiogenic liver abscesses, biliary pancreatitis, pancreatic necrosis, and severe concomitant pathology. Conclusions. Cholelithiasis occupies the first position in the morbidity pattern of diseases of general surgical profile in Ryazan district, and laparoscopic cholecystectomy is the most common operation in surgical hospitals. There is noted an increase in the complicated forms of cholelithiasis and in lethality, which requires optimization of the therapeutic approach for such patients, and conduction of treatment in specialized hospitals.