Application of fuzzy mathematical model of decision-making for the selection of optimal surgical tactics in patients with non-tumor obstructive jaundice
- Authors: Gadzhiev D.N1, Tagiev EG1, Gadzhiev ND.1, Shikhlinskaya RY.1
-
Affiliations:
- Azerbaijan Medical University
- Issue: Vol 99, No 3 (2018)
- Pages: 439-445
- Section: Theoretical and clinical medicine
- URL: https://ogarev-online.ru/kazanmedj/article/view/8897
- DOI: https://doi.org/10.17816/KMJ2018-439
- ID: 8897
Cite item
Full Text
Abstract
Aim. Creation of a model of fuzzy logic for predicting the risk of postoperative complications and the choice of individual optimal surgical tactics in obstructive jaundice caused by choledocholithiasis. Methods. At the first stage, we determined the most prognostically significant factors affecting the risk of postoperative complications. In accordance with these factors, linguistic variables were introduced: X1 - patient’s age; X2 - duration of jaundice; X3 - temperature; X4 - comorbidities; X5 - the level of liver dysfunction; X6 - CD4+ in the blood; X7 - interleukin-2 in the serum; Y - level of risk. The intervals of their changes were determined. Fuzzi Logic Toolbox Matlab soft was used to achieve the determined aim. The values of input variables were introduced into the model, transformed in the «Phaser» block and then the rule base of the fuzzy inference system was formed by the expert method. As a result, the level of risk is determined and the choice of surgical tactics is made: (1) risk is absent or low (A); (2) doubtful risk (B) - if the risk assessment in the dynamics after preoperative therapy decreases, then tactics A, if the score does not decrease or increases, then tactics C; (3) high and very high risk (C) - an unequivocal choice of stage tactics. Results. According to the defined level of risk, in 92 patients a one-stage procedure was used, while 58 underwent a two-stage intervention. Due to the developed fuzzy mathematical model, forecasting of the optimal choice of surgical tactics is achieved, which significantly improves the results of treatment. Conclusion. The developed fuzzy mathematical model makes it possible to differentiate the choice of surgical tactics for a particular patient and thereby reduce the incidence of postoperative complications from 29.0 to 4.7% and mortality from 11.0 to 1.3%.
Full Text
##article.viewOnOriginalSite##About the authors
Dzh N Gadzhiev
Azerbaijan Medical University
Author for correspondence.
Email: elman.tagiyev@mail.ru
Baku, Azerbaijan
E G Tagiev
Azerbaijan Medical University
Email: elman.tagiyev@mail.ru
Baku, Azerbaijan
N Dzh Gadzhiev
Azerbaijan Medical University
Email: elman.tagiyev@mail.ru
Baku, Azerbaijan
R Yu Shikhlinskaya
Azerbaijan Medical University
Email: elman.tagiyev@mail.ru
Baku, Azerbaijan
References
- Cherkasov M.F., Kuz'menko V.L. Possibility of forecasting cholecystectomy long-term results. Sovremennye problemy nauki i obrazovaniya. 2016; (3): 96–102. (In Russ.)
- Bulian D.R., Trump L., Knuth J. et al. Long-termresults of transvaginal/transumblikal versus classical laparoscopic cholecystektomy — an analysis of 88 paticents. Langenbecks Arch. Surg. 2013; 398: 571–579. doi: 10.1007/s00423-013-1071-8.
- Gal'perin E.I., Vetshchev P.S. Rukovodstvo po khirurgii zhyolchnkyh putey. (Guide on biliary tract surgery.) Moscow: Vidar-M. 2006; 568 p. (In Russ.)
- Ermakov E.A., Lishchenko A.N. Diagnosis of major duodenal papilla in patients with choledocholithiasis. Vestnik khirurgii im. I.I. Grekova. 2007; (4): 80–83. (In Russ.)
- Maystrenko N.A., Stukalov V.V. Holedoholitiaz. (Choledocholithiasis.) Saint Petersburg: ELBI-SPb. 2000; 288 p. (In Russ.)
- Tagiev E.G. Interleukin-4 dynamics in patients with benign obstructive jaundice surgical management. Zdravookhranenie. 2016; (5): 4–8. (In Russ.)
- Maystrenko N.A., Stukalov V.V., Pryadko A.S. et al. Diagnosis and treatment of the benign genesis obstructive jaundice syndrome. Annaly khirurgicheskoy gepatologii. 2011; (3): 26–34. (In Russ.)
- Sedov A.P., Parfenov I.P., Yarosh A.L. et al. Assessment of bile duct mucosa and bile composition changes in assessment of bile duct mucosa and bile composition changes in acute aholangitis patients. Annaly khirurgicheskoy gepatologii. 2009; (2): 22–27. (In Russ.)
- Alekseev N.A., Baranov A.I., Snigirev Ju.B. Intraoperative antegrade endoscopic papillosphincterotomy in the treatment of complications cholelithiasis. Novye tekhnologii. Voprosy rekonstruktivnoy i plasticheskoy khirurgii. 2015; (4): 21–26. (In Russ.)
- Boyer J.L. New perspectives for the treatment of cholestasis: lessons from basic science applied clinically. J. Hepatol. 2007; 46: 365–371. doi: 10.1016/j.jhep.2006.12.001.
- Shapoval'janc S.G., Myl'nikov A.G., Nikonov A.A. et al. Prevention and treatment of recurrent choledocholithiasis. Annaly khirurgicheskoy gepatologii. 2013; (1): 16–22. (In Russ.)
- Ardasenov T.G., Budzinskij S.A., Pan'kov A.G. et al. Peculiarity of surgical management of difficult common bile duct stones. Annaly hirurgicheskoj gepatologii. 2013; 18 (1): 23–28. (In Russ.)
- Shulutko A.M., Agadzhanov V.G., Natroshvili A.G., Natroshvili I.G. Minimally invasive surgery in cholecisto-choledocholithiasis . Annaly hirurgicheskoj gepatologii. 2013; (1): 38–41. (In Russ.)
- Ivanov A.V., Mishustin V.N., Lazurina L.P., Serebrovskiy V.I. Fuzzy mathematical models of decision support system for acute pancreatitis prediction problems solving. Doctor and information technology. 2013; (6): 60–66. (In Russ.)
- Litvin A.A., Litvin V.A. Clinical decision support systems for surgery. Novosti khirurgii. 2014; 22 (1): 96–100. (In Russ.)
- Hajiyev C.N., Shikhlinskaya R.Y., Allahverdiyev V.A., Hajiyev N.C. Modern aspects of predicting recurrence of bleeding in acute gastroduodenal ulcer. Azerbaijan medical journal. 2016; (3): 81–89. (In Azerb.)
- Zadeh L.A. Fuzzy Sets. Inform. and Control. 1965; 8: 338–353.
Supplementary files
