Биология ва тиббиёт муаммолари 2026, №5 (171)

Maqola mavzusi

PREOPERATIVE RECOGNITION OF GALLBLADDER WALL DESTRUCTION IN ACUTE CHOL-ECYSTITIS: CLINICAL, LABORATORY AND IMAGING PREDICTORS (306-312)

Mualliflar

Ruziyev Panji Nabiyevich, Kadirov Rustam Nadirovich

Muassasa

Samarkand Branch of the Republican Scientific Center for Emergency Medical Care, Republic of Uzbekistan, Samarkand

Annotatsiya

Aim: to assess how reliably the depth of gallbladder wall destruction in acute cholecystitis can be recognised before surgery from clinical, laboratory and imaging findings. Materials and methods: this single-centre retro-spective–prospective study included 281 patients treated in 2019–2026; the phlegmonous form was found in 154 (54.8%), the gangrenous form in 101 (35.9%) and the gangrenous-perforative form in 26 (9.3%). Clinical find-ings, inflammatory biomarkers, ultrasonography, computed tomography and duplex Doppler findings were re-lated to morphological severity and to intraoperative difficulty according to Nassar/Parkland. Results: symptom duration increased from 42.6 ± 18.7 h in phlegmonous disease to 71.8 ± 31.6 h in gangrenous-perforated disease (p < 0.001); after 72 h the proportion of Nassar III–IV operations rose from 30.6% to 94.2%. Murphy’s sign fell from 86.4% to 65.4% while peritoneal signs rose from 13.6% to 84.6%; in patients aged ≥ 60 years and in diabe-tes Murphy’s sign was present in only 72.8% and 67.3%. Ultrasonography detected gangrene with 61.4% sensi-tivity and 79.2% specificity, compared with 72.7% and 80.0% for CT. Procalcitonin and C-reactive protein yield-ed AUCs of 0.86 and 0.84. Avascular areas on duplex scanning were found in 20.0% of gangrenous versus 2.7% of phlegmonous cases (p < 0.001). Conclusion: no single criterion recognises the depth of destruction; the time factor, clinical presentation, inflammatory activity and imaging findings have to be weighed together, and this combination forms the basis of a 10-point preoperative score (AUC 0.84).

Kalit so'zlar

acute destructive cholecystitis, gangrenous cholecystitis, ultrasonography, computed tomography, procalciton-in, C-reactive protein, duplex scanning, difficult cholecystectomy.

Adabiyotlar

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