PATHOGENETIC CLASSIFICATION OF CHOLANGITIS

Summary. Introduction. In the context of a wide variety of forms of acute and chronic cholangitis and a wide range of interventions, it is advisable to create a classification that facilitates the solution of tactical and strategic issues of treating patients with this serious disease. Materials and methods. 200 patients with acute and chronic cholangitis were selected. There were 93 men, 107 women, the average age of the patients was (61.8±2.4) years. Results of the study and their discussion. It is advisable to distinguish four groups of patients with acute and chronic cholangitis: I group. The pathological process is localized only in the lumen of the main ducts. Surgical tactics of treatment of these patients is urgent endoscopic papilosphincterotomy (EPST) and clearence of the ductal system. II group. The walls of the main bile ducts are involved in the pathological process, which led to their deformation and stricture. The vast majority of operations in this group are the reconstruction of the biliary tree. III group. Patients with chronic recurrent cholangitis who have already undergone biliary reconstruction, but which did not prove to be effective or was complicated by various types of new strictures. IV group. Patients with obstruction of the biliary tract caused by a cause localized outside the biliary system. In these patients, as a rule, the phenomena of cholangitis are mild, and the manifesting symptoms are biliary hypertension and liver failure. Conclusions. The use of the proposed classification, based on the pathogenetic features of the development of cholangitis in various pathomorphological conditions, makes it possible to clearly define the issues of surgical tactics.