Issue: 2016, Vol. 21, No. 2
THE DYNAMICS OF THE INDICES OF VOLATILE FAT ACIDS, CITRULLINE AND MALONDIALDEHYDE IN THE COMPLEX EVALUATION OF HEPATIC INSUFFICIENCY IN PATIENTS WITH MECHANICAL JAUNDICE AND PURULENT CHOLANGITIS
- Keywords
- mechanical jaundice, purulent cholangitis, hepatic insufficiency, volatile fat acids, citrulline, malondialdehyde
- Abstarct
- Objective - to study the importance of volatile fat acids indices, citrulline and malondialdehyde in the complex preoperative estimation of hepatic insufficiency in patients with mechanical jaundice and purulent cholangitis in order to select optimal surgical tactics. Material and methods. 39 patients with mechanical jaundice and purulent cholangitis (average age 60 ± 2 years) were examined from 2010 to 2015. Gall duct content was analyzed bacteriologically. Two-stage surgical tactics was selected with due regard to the diagnosed purulent cholangitis. Volatile fat acids level was determined by gasliquid chromatography, levels of citrulline and malondialdehyde - by spectrophotometry. Repeated examinations were performed on the background of biliary decompression and intensive complex treatment. Results . Statistically significant increase of average concentrations of volatile fat acids, citrulline and malondialdehyde were found in all patients; it correlated with the deterioration of laboratory and integral indices. Two groups of patients were singled out upon the results of volatile fat acids examination: 1 group was composed of 31 patients with such indices of volatile fat acids which testified to accidental anaerobic microflora presence, 2 group was composed of 8 patients with such indices of volatile fat acids which testified to obligatory anaerobic microflora presence which caused anaerobic infection. The concentration of acetic acid was increased to a considerable extent in the first group, the heightened concentrations of all examined volatile fat acids were found in the second group. The duration and effectiveness of biliary decompression were defined with due regard to singled groups. At different stages after biliary decompression using statistically significant decrease of the examined parameters the researchers stated hepatic insufficiency regress and performed basic operative interventions. Conclusions . The increased concentrations of volatile fat acids, citrulline and malondialdehyde were proved to be one of objective signs of hepatic insufficiency in patients with mechanical jaundice and purulent cholangitis. Analysis of volatile fat acids was allowed to use as an express method to diagnose anaerobic infection which caused the most severe forms of purulent cholangitis. Indices of volatile fat acids, citrulline and malondialdehyde allowed to make objective estimation of the reaction of the organism to preoperative preparation and biliary decompression and determined the optimal terms to perform radical operation.
Вальков