rfhealthЗдравоохранение Российской ФедерацииHealth care of the Russian Federation0044-197X2412-0723Federal Scientific Center of Hygiene named after F.F. Erisman10.46563/0044-197X-2020-64-6-324-328rfhealth-233Research ArticleПРОБЛЕМЫ СОЦИАЛЬНО ЗНАЧИМЫХ ЗАБОЛЕВАНИЙPROBLEMS OF SOCIALLY SIGNIFICANT DISEASESОстрый холецистит у больных с COVID-19: ведение в условиях перепрофилированного многопрофильного стационараThe acute cholecystitis in COVID-19 patients: treatment in conditions of reprofiled hospitalhttps://orcid.org/0000-0003-1412-5616БаглаенкоМ. В.BaglaenkoMaxim V.noemail@neicon.ruhttps://orcid.org/0000-0003-3568-5065ВечоркоВ. И.VechorkoValery I.noemail@neicon.ruАносовВиктор ДавидовичAnosovViktor D.

Канд. мед. наук, и.о. заместителя главного врача по хирургической помощи ГБУЗ г. Москвы «Городская клиническая больница № 15 имени О.М. Филатова Департамента здравоохранения города Москвы», 111539, Москва.

e-mail: avsurg@mail.ru

MD, Ph.D., acting chief physician for surgical care, Municipal Clinical Hospital № 15 named after O.M. Filatov of Moscow Healthcare Department, Moscow, 111539, Russia.

e-mail: avsurg@mail.ru

avsurg@mail.ruhttps://orcid.org/0000-0002-4172-8263ГуменюкС. А.GumenyukSergey A.noemail@neicon.ruhttps://orcid.org/0000-0002-3983-7890РогожинаЛ. С.RogozhinaLyudmila S.noemail@neicon.ruГБУЗ «Городская клиническая больница № 15 имени О.М. Филатова Департамента здравоохранения города Москвы»Municipal Clinical Hospital № 15 named after O.M. Filatov of Moscow Healthcare DepartmentГБУЗ «Научно-практический центр экстренной медицинской помощи Департамента здравоохранения города Москвы»Scientific and Practical Center for Emergency Medical Aid of Moscow Healthcare Department202001012021646324328Copyright © Баглаенко М.В., Вечорко В.И., Аносов В.Д., Гуменюк С.А., Рогожина Л.С., 20212021Баглаенко М.В., Вечорко В.И., Аносов В.Д., Гуменюк С.А., Рогожина Л.С.Baglaenko M.V., Vechorko V.I., Anosov V.D., Gumenyuk S.A., Rogozhina L.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rfhealth.ru/jour/article/view/233Введение

Введение. Во время пандемии COVID-19 оказание плановой хирургической помощи было приостановлено. Для лечения больных острым холециститом предлагается консервативное лечение, чрескожное дренирование желчного пузыря или холецистэктомия. Тактика лечения больных острым холециститом на фоне COVID-19 не изучена. Важно проанализировать данные, касающиеся времени проведения холецистэктомии при остром холецистите, сравнить эффективность «ранней» и «отсроченной» холецистэктомии, которая проводится после периода консервативной терапии.

Цель работы - представить и оценить результаты лечения больных острым холециститом на фоне COVID-19 в условиях перепрофилированного многопрофильного стационара.

Материал и методы

Материал и методы. В ретроспективное сравнительное исследование с историческим контролем включены 16 пациентов с острым холециститом на фоне COVID-19. Синдром механической желтухи диагностирован у 3 (18,75%) пациентов. Диагноз COVID-19 с помощью метода полимеразной цепной реакции (ПЦР) подтвержден у 5 пациентов, серологическим методом - у 2 пациентов и у 9 пациентов диагноз подтвержден рентгенологическим или компьютерно-томографическим исследованием при отрицательных/сомнительных результатах теста ПЦР.

Результаты

Результаты. Оперировано 9 (56,25%) пациентов, чрескожные вмешательства выполнены у 4 (25%), консервативная терапия - у 3 (18,75%). Большинство пациентов прооперировано в течение 1 сут с момента поступления. В основной группе летальный исход имел место в 1 (6,25%) случае (смерть от тромбоэмболического осложнения у пациентки с синдром механической желтухи).

Обсуждение

Обсуждение. Выбор «ранней» холецистэктомии при остром холецистите при условии стабильного состояния и начальных изменений легких представляется уместным у большинства пациентов с COVID-19.

Заключение

Заключение. Выполнение холецистэктомии у больных с COVID-19 в условиях инфекционного стационара не привело к увеличению продолжительности стационарного лечения, частоты осложнений. Обозначенные в результатах работы подходы могут быть использованы как безопасный метод в обсуждаемой категории пациентов.

Introduction

Introduction. Routine surgical care has been suspended during the COVID-19 pandemic. For the treatment of patients with acute cholecystitis, conservative treatment, percutaneous drainage of the gallbladder or cholecystectomy is offered. Tactics of treatment of patients with acute cholecystitis against the background of COVID-19 have not been studied. It is important to study the data concerning the time of cholecystectomy in acute cholecystitis, comparing “early” and “delayed” cholecystectomy, which is performed after a period of conservative therapy.

Aim

Aim. To present and evaluate the results of treatment of patients with acute cholecystitis against the background of COVID-19 in the conditions of a repurposed multi-specialty hospital on the basis of the O. M. Filatov Clinic Hospital No. 15 in Moscow.

Material and methods

Material and methods. A retrospective comparative study with history control included 16 patients with acute cholecystitis against the background of COVID-19. Mechanical jaundice syndrome was diagnosed in 3 (18.75%) patients. The diagnosis of coronavirus infection using PCR was confirmed in 5 patients, serological method-in 2 patients, and in 9 patients the diagnosis was confirmed by X-ray or CT examination with negative/doubtful PCR test results.

Results

Results. Nine (56.25%) patients were operated 4 (25%) percutaneous interventions were performed, in 3 (18.75%) cases conservative therapy was performed. Most patients were operated on within the first day of admission. In the main group, a fatal outcome occurred in 1 (6.25%) case (death from a thromboembolic complication in a patient with mechanical jaundice syndrome).

Discussion

Discussion. The choice of «early» cholecystectomy for acute cholecystitis, provided the condition is stable and the initial changes in the lungs are appropriate in most COVID-19 patients.

Conclusion

Conclusion. Performing cholecystectomy in patients with coronavirus infection in an infectious hospital did not lead to an increase in the duration of inpatient treatment and the prevalence of complications. The approaches mentiobed in the results section can be used as a safe method in the discussed category of patients.

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The authors declare that there are no conflicts of interest present.