Application of fuzzy mathematical model of decision-making for the selection of optimal surgical tactics in patients with non-tumor obstructive jaundice

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%.

Keywords

obstructive jaundice / choledocholithiasis / fuzzy logic / linguistic index

References

[1] 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.)

[2] Черкасов М.Ф., Кузьменко В.Л. Возможность прогнозирования отдалённых результатов холецистэктомии. Соврем. пробл. науки и образования. 2016; (3): 96-102.

[3] 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.

[4] 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.

[5] 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.)

[6] Гальперин Э.И., Ветщев П.С. Руководство по хирургии жёлчных путей. М.: Видар-М. 2006; 568 с. .

[7] 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.)

[8] Ермаков Е.А., Лищенко А.Н. Диагностика стеноза большого сосочка двенадцатиперстной кишки у больных с холедохолитиазом. Вестн. хир. им. И.И. Грекова. 2007; (4): 80-83.

[9] May­strenko N.A., Stukalov V.V. Holedoholitiaz. (Chole­docholithiasis.) Saint Petersburg: ELBI-SPb. 2000; 288 p. (In Russ.)

[10] Майстренко Н.А., Стукалов В.В. Холедохолитиаз. СПб.: ЭЛБИ-СПб. 2000; 288 с.

[11] Tagiev E.G. Interleukin-4 dynamics in patients with benign obstructive jaundice surgical management. Zdravookhranenie. 2016; (5): 4–8. (In Russ.)

[12] Тагиев Э.Г. Динамика интерлейкина-4 при хирургическом лечении механической желтухи доброкачественного генеза. Здравоохранение. 2016; (5): 4-8.

[13] 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.)

[14] Майстренко Н.А., Стукалов В.В., Прядко А.С. и др. Диагностика и лечение синдрома механической желтухи доброкачественного генеза. Анн. хир. гепатол. 2011; (3): 26-34.

[15] 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.)

[16] Седов А.П., Парфёнов И.П., Ярош А.Л. и др. Оценка изменений слизистой оболочки жёлчных протоков и состава жёлчи при остром холангите. Анн. хир. гепатол. 2009; (2): 22-27.

[17] 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.)

[18] Алексеев Н.А., Баранов А.И., Снигирев Ю.Б. Интраоперационная антеградная эндоскопическая папиллосфинктеротомия в лечении осложнённой желчнокаменной болезни. Новые технологии. Вопр. реконструктивн. и пластическ. хир. 2015; (4): 21-26.

[19] 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.

[20] 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.

[21] 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.)

[22] Шаповальянц С.Г., Мыльников А.Г., Никонов А.А. и др. Профилактика и лечение рецидивного холедохолитиаза. Анн. хир. гепатол. 2013; (1): 16-22.

[23] 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.)

[24] Ардасенов Т.Г., Будзинский С.А., Паньков А.Г. и др. Особенности хирургического лечения сложных форм холедохолитиаза. Анн. хир. гепатол. 2013; 18 (1): 23-28.

[25] 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.)

[26] Шулутко А.М., Агаджанов В.Г., Натрошвили А.Г., Натрошвили И.Г. Минимально инвазивные операции при холецистохоледохолитиазе. Анн. хир. гепатол. 2013; (1): 38-41.

[27] 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.)

[28] Иванов А.В., Мишустин В.Н., Лазурина Л.П., Серебровский В.И. Нечёткие математические модели системы поддержки принятия решений для решения задачи прогнозирования острого панкреатита. Врач и информ. технол. 2013; (6): 60-66.

[29] Litvin A.A., Litvin V.A. Clinical decision support systems for surgery. Novosti khirurgii. 2014; 22 (1): 96–100. (In Russ.)

[30] Литвин А.А., Литвин В.А. Системы поддержки принятия решений в хирургии. Новости хирургии. 2014; 22 (1): 96-100.

[31] 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.)

[32] Hacıyev C.N., Şıxlinskaya R.Y., Allahverdiyev V.A., Hacıyev N.C. Xora mənşəli kəskin qastroduodenal qanaxma residivlərin proqnozlaşdırılmasının müasir aspektləri. Azərbaycan Tibb Jurnalı. 2016; (3): 81-89.

[33] Zadeh L.A. Fuzzy Sets. Inform. and Control. 1965; 8: 338–353.

[34] Zadeh L.A. Fuzzy Sets. Inform. and Control. 1965; 8: 338-353.

RIGHTS & PERMISSIONS

Gadzhiev D.N., Tagiev E.G., Gadzhiev N.D., Shikhlinskaya R.Y.