Optimization of the treatment of liver failure in patients with obstructive jaundice

Aim. Gptimization of the results of treatment of liver failure in patients with obstructive jaundice. Materials and methods. The results of diagnosis and complex therapy of liver failure in 38 patients with obstructive jaundice (GJ) of moderate and severe severity were analyzed. The main causes of GJ were: choledocholithiasis - in 15 (39.5%) cases, cicatricial stricture of the biliary tract and formed biliodigestive anastomoses - in 9 (23.7%) patients, stenosis of the major duodenal papilla - in 6 (15.8%) cases, rupture of the echinococcal cyst of the liver into the bile ducts - in 4 (10.5%) cases and Mirrizi’s syndrome - in 4 (10.5%) cases. According to the severity of GJ, the patients were distributed in accordance with the classification proposed by E.I. Galperin et al. (2012) [13]. It should be noted that patients with muscular jaundice class A (mild) were not found in the study. There were 17 (44.7%) patients with class B (moderate severity of diseases) of a mixture of jaundice of qualitative origin, with class C (severe severity) - 21 (55.3%). Liver failure in the stage of subcompensation was observed in 20 (52.6%) patients, in the stage of decompensation - in 18 (47.4%). It should be noted that in 14 (36.8%) cases in patients with GJ complicated by liver failure, hepatic encephalopathy was observed. Results. For the treatment of breast cancer, especially for the prevention and treatment of liver and multiple organ failure, in patients with moderate and severe grade B and C jaundice, the molecular adsorbent recirculating system (MARS) was used in combination with the antihypoxant and antioxidant agent Remaxol. The combined use of MARS-therapy with antihypoxant-antioxidant therapy in class C GJ patients with symptoms of liver failure made it possible to effectively stop the manifestations of the complication. Against the background of the therapy, patients showed positive changes in dynamic indicators reflecting the state of the protein-synthetic functional ability of the liver, such as an increase in the level of albumin in the blood plasma - by 13.5% and the amount of cholesterol - by 23.3%. So, by this time, the indicators of AsAt decreased by 17%, the indicators of AlAt - by 12.2%, and the indicators of alkaline phosphatase and gamma-glutamyl transferase by 15.9% and 26%. Also, after 7 days from the start of therapy, a decrease in the indices of all fractions of bilirubin was observed. At the same time, the indicators of total bilirubin decreased by 56% relative to the initial values. Starting from the 2nd-5th day of the study, a decrease in the level of DC to 1.5±0.03 opt. pg/ml and 1.2±0.01 op. pg/ml and MDA - 3.4±0.21 mmol/mg and 3.1 ±0.18 nmol/mg. Also during these periods there was a decrease in blood lactate to 2.0±0.6 mmol and 1.9±0.4 mmol, respectively. Conclusion. Thus, the use of MARS-therapy in combination with antihypoxic and antioxidant agents in the treatment of patients with breast cancer, complicated by the development of liver failure, showed its high efficiency, the absence of adverse and side effects that may be observed in the development of postoperative complications.