Structural and functional state of the liver in patients with extrahepatic cholestasis of non-tumor genesis
To date, the diagnosis and treatment of extrahepatic cholestasis (EHC) at various stages of development remains one of the most pressing problems of modern biliary surgery. The purpose of the study is to determine the structural changes of the liver in patients with EHC of non-tumoral genesis according to shear wave elastometry and ultrasound in comparison with biochemical indicators of endotoxemia, inflammation and markers of fibrosis. Preoperatively, 121 patients with EHC of non-tumoral genesis were examined: standard general clinical studies, ultrasound examination of the liver and its shear wave elastometry were performed. Depending on the presence of jaundice and symptoms of hepatocyte damage, all the patients were divided into 4 groups. Serum content of medium molecular weight peptides, free hydroxyproline and glycosaminoglycans was determined. Statistical processing of the obtained data was performed using SPSS 16.0. In patients with EHC of non-tumoral genesis according to shear wave elastography, the stiffness of the liver varied depending on the increase in the intensity of jaundice. It was found that the serum bilirubin level in such patients was significantly different depending on the available jaundice and symptoms of hepatocyte damage both in comparison with the control group and between the study groups. In EHCs, structural changes in the liver depend on abnormalities in the biochemical composition of serum, which are significantly altered by prolonged extrahepatic cholestasis and manifested by severe liver failure. Thus, an increase in endotoxemia (p<0.001) was found in patients with EHC of non-tumoral genesis without jaundice and evidence of cholestasis development; indicators of liver stiffness depend on the level of bilirubinemia (r = 0.84), and in patients with hepatocyte damage also on the duration of cholestasis (r = 0.68). Bilirubin levels cannot be an indicator of long-term EHC.
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