Efficacy of Infusion Ozone Therapy in the Comprehensive Treatment of Patients with Cholelithiasis

The dissertation is devoted to studying the efficacy of infusion ozone therapy in the comprehensive treatment of patients with cholelithiasis. Cholelithiasis is one of the most common diseases of the digestive organs, involving the hepatobiliary and gastroduodenal systems, the pancreas, and the intestine in the pathological process. The work investigates lipid peroxidation processes, the antioxidant defense system, and endogenous intoxication levels in patients with cholelithiasis. The aim of the study is to improve surgical outcomes through the use of infusion ozone therapy in the postoperative period.

The research results were implemented in the clinical practice of the Department of Surgical Gastroenterology and Endocrinology of the Clinic of Academician I.K. Akhunbaev of the National Hospital of the Ministry of Health of the Kyrgyz Republic. The main findings of the dissertation were presented at the XIII International Congress of Surgeons-Hepatologists of the CIS Countries and at scientific and practical conferences in Bishkek. Five scientific works have been published on the topic of the dissertation.

Cholelithiasis (CH) is one of the most common diseases of the digestive organs. Over the past decade, there has been an increase in the incidence of CH in Russia and abroad. Moreover, it is increasingly observed not only in adults but also in children (A.S. Loginov, 2001; V.A. Galkin, 2003). According to some data, acute cholecystitis ranks second (S.A. Dadvani et al., 2000; V.E. Vasiliev, A.B. Perunov, 2001), while according to others, it ranks third in the structure of acute surgical diseases after acute pancreatitis and acute appendicitis (A.S. Ermolov et al., 1999; I.I. Zatevakhin et al., 2000). In Russia and the CIS countries, more than 100,000 cholecystectomies are performed annually for acute cholecystitis and CH. The mortality rate among elderly and senile patients exceeds 20% (M.A. Galeev et al., 2001).

Due to the commonness of blood supply, innervation, and topographic proximity, the pathological process in CH involves the hepatobiliary, gastroduodenal systems, the pancreas, and the intestine (T.D. Zvyagintsev, A.V. Dergacheva, 1998; A.K. Grafov, 1995, 1996, 2006; E.A. Reshetnikov et al., 2005; E.I. Brekhov et al., 2006; V.P. Kochukov, 2006; A.S. Mironov et al., 2006; A.S. Mironov, 2007). Literature data indicate that lipid peroxidation (LPO) processes and the antioxidant defense system (AOS) play an important role in the mechanism of their damage. The resulting pathology is, to a significant extent, the result of oxidative stress due to a decrease in the protective function of the antioxidant defense system (Yu.A. Vladimirov, 1989; E.V. Makarenko, I.V. Kozlovsky, 1989; P.Ya. Grigoriev, E.P. Yakovenko, 1990; E.E. Dubinina, 1990; A.N. Prutskova et al., 2004; O.Z. Mustaev, 2006).

In the pathogenesis of liver damage and liver failure in cholelithiasis, the accumulation of LPO products in the body plays a significant role (G.A. Gavrilenko et al., 1995; B.N. Matyushin et al., 1995; S.A. Brass, T.G. Roberts, 1995).

Ozone is an allotropic form of oxygen with high chemical activity, consisting of three oxygen molecules. Ozone therapy is a therapeutic method that has found increasingly wide application in clinical practice in recent years due to the wide range of therapeutic effects of ozone. Ozone contributes to the reduction of inflammatory reactions, activation of the phagocytic function of leukocytes and antioxidant defense, reduction of catabolism, and enhancement of the adaptive capabilities of the organism (G.A. Sinegub, V.Ya. Zaitsev, 1991; M.A. Aliev, L.P. Ioffe, 1993; K.S. Sarbanova, L.V. Storozhaeva, 1998; L.A. Laberko et al., 2000; A.A. Daulbaeva, 2002; I.K. Iskanderova, 2006; M.V. Varganov, 2006; V.S. Kononov, 2007).

Despite studies of LPO processes and the AOS in patients with various gastrointestinal pathologies and the application of ozone therapy in the treatment of these diseases, research on LPO-AOS processes in patients with cholelithiasis and the effect of parenteral ozone therapy on the dynamics of LPO and AOS indicators remains insufficiently covered to date, which necessitates further study of this problem.

Aim of the study:

Improving the results of surgical treatment of patients with cholelithiasis through the use of infusion ozone therapy in the postoperative period.

Research objectives:

1. To study lipid peroxidation processes and antioxidant defense system indicators in patients with cholelithiasis before surgery and in the postoperative period.

2. To evaluate the effect of infusion ozone therapy on lipid peroxidation and the antioxidant defense system in patients with cholelithiasis after surgery.

3. To determine the clinical efficacy of infusion ozone therapy in the comprehensive treatment of patients with cholelithiasis.

Scientific novelty:

1. The influence of infusion ozone therapy on lipid peroxidation processes in the postoperative period in patients with cholelithiasis has been determined.

2. The influence of infusion ozone therapy on the antioxidant defense system in the postoperative period in patients with cholelithiasis has been established.

3. The efficacy of infusion ozone therapy in the comprehensive treatment of patients with cholelithiasis has been demonstrated compared to traditional treatment methods.

Practical significance:

1. The study of LPO processes and the antioxidant defense system reveals deep metabolic disorders in patients with cholelithiasis before surgery and changes in these disorders in the postoperative period.

2. The use of infusion ozone therapy after surgery in combination with traditional therapeutic measures allows for acceleration of the correction of metabolic disorders, as expressed by the dynamics of LPO product and antioxidant defense system indicators.

3. The inclusion of ozone therapy in traditional treatment of patients with cholelithiasis makes it possible to obtain a number of positive clinical effects and reduce the length of hospital stay.

Author's contribution:

The author's personal contribution to obtaining the results presented in the dissertation was carried out at all stages of the work. The author personally conducted the search and analysis of literary data, performed the selection of patients with cholelithiasis, personally participated in conducting specialized laboratory studies, participated in surgical operations, engaged in postoperative treatment of patients, prepared an ozone-infused physiological solution, and performed ozone therapy. The author formed the database, conducted statistical processing using the MS Excel XP software package, and analyzed the obtained results.

Main findings for defense:

1. LPO and AOS processes in patients with cholelithiasis are significantly intensified compared to healthy individuals. In the postoperative period, a high level of secondary LPO products persists in the blood plasma of patients.

2. Infusion ozone therapy in the postoperative period significantly inhibits lipid peroxidation processes and reduces endogenous intoxication in patients with cholelithiasis.

3. The application of infusion ozone therapy after surgery in patients with cholelithiasis is expressed by positive clinical effects.

Implementation of research results:

The research results have been implemented in the clinical practice of the Department of Surgical Gastroenterology and Endocrinology of the Clinic of Academician I.K. Akhunbaev of the National Hospital of the Ministry of Health of the Kyrgyz Republic.

Defense of the dissertation:

The main findings of the dissertation were presented at the XIII International Congress of Surgeons-Hepatologists of the CIS Countries (Almaty, 2006); at a scientific and practical conference of the medical faculty of the Kyrgyz-Russian Slavic University named after B.N. Yeltsin (Bishkek, 2007); at a joint meeting of the staff of the Department of Hospital Surgery and the Department of General and Faculty Surgery of the Kyrgyz-Russian Slavic University named after B.N. Yeltsin, the Department of Surgical Diseases No. 1 of the Kyrgyz State Medical Academy, and the staff of the Clinic of Academician I.K. Akhunbaev of the National Hospital of the Ministry of Health of the Kyrgyz Republic (Bishkek, 2007).

Publications:

Five scientific works have been published on the topic of the dissertation.

Volume and structure of the dissertation:

The dissertation is presented in 85 pages of computer typesetting in Russian. The dissertation consists of an introduction, 4 chapters, a conclusion, findings, practical recommendations, and a reference list. The reference list includes 195 sources: 130 domestic authors and authors of CIS countries, and 65 foreign authors. The dissertation is illustrated with 17 figures and 5 tables.