EVOLUTION OF VIEWS ON PROBLEMS OF HUMAN-SCAMMARY DISEASE IN PERM REGION

Gallstone disease has been known since ancient times. In the XIX century, two theories of the appearance of gallstones were proposed: the primary pathology of the liver and stagnation in the gallbladder. Later, they were supplemented by ideas of participation of a microbial agent and violation of cholesterol metabolism. In the XX century, cholestotomy, cholecystostomy and cholecystectomy were performed. Differences in the quality of stones have been noted for a long time. Elemental composition of different stones in the form was the same. By the 1980s of the twentieth century there were three main theories of the pathogenesis of gastrointestinal tract: infectious, bile stagnation and lipid metabolism disorders. None of them solved the problem. Pathogenesis remained at the level of assumptions. The results of surgical treatment of calculous cholecystitis did not always match the expected results. The term “postcholecystectomy syndrome” was proposed to characterize pathological conditions after surgical treatment of gallbladder diseases. In the Perm State Medical Institute, a number of works appeared at the Department of Hospital Surgery, in which the correlation of clinical, biochemical and morphological changes in the liver with cholelithiasis was investigated. L. F. Palatova laid the direction of studying the relationship of standing of the liver and the course of cholelithiasis. L. P. Kotelnikova, based on the spectral study of concrements, it was suggested that they are formed as a result of a lipid distress syndrome, where the liver and biliary tract serve as the target organ. The peculiarities of ultrastructural changes were discovered by T. I. Subbotin in persons with SCI who had previously suffered hepatitis B. Disturbances of blood supply and microcirculation in stenoses of the fat nipple and choledocholithiasis are studied in the candidate’s thesis by V. M. Rusinov. A. V. Popov and D. V. Shvarev investigated the polymorphism in CHD, indications for surgery and the results of treatment and rehabilitation, including resort. L. B. Guschensky shows the relationship of pathological processes in HDB and pancreatitis. Complications of choledocholithiasis, in particular, cholangitis, are covered in the work of D. I. Dremin. The role of the intestinal microbiota in the course of pathological processes in the biliary tract was studied by NA. Zubareva. The influence of pre-operative dispensary, surgical tactics on the outcomes of treatment is shown in doctoral dissertations. Kotelnikova and P. Ya. Sandakova. The idea of the pathogenesis and course of CSF has come a long way, and there are still unresolved issues in this problem, and surgical treatment has also evolved from large surgical interventions to stage manipulations from small accesses, which allows the patient to escape from extensive operational trauma, shortens treatment time and improves the quality of life.

Gallstone disease, the composition of concrements, postcholecystectomy syndrome, holedohoduodenoanastomoz, cholecystolithiasis, cholangitis, mechanical jaundice

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