MODERN TECHNOLOGIES FOR THE DIAGNOSIS OF BILIARY TRACT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE
Summary. Introduction. Diseases of the biliary tract can have a malignant, incendiary and traumatic etiology and be accompanied by a syndrome of obstructive jaundice.
Objective: to study the effectiveness and specificity of modern technologies for the diagnosis of biliary tract diseases complicated by obstructive jaundice.
Materials and research methods. We analyzed the instrumental examination of 118 patients with biliary tract diseases complicated by obstructive jaundice.
Results and its discussion. Ultrasound is the first screening test in the diagnosis of biliary tract diseases. Ultrasound was performed in 74 (62.7 %) patients. The sensitivity of ultrasound as an indicator of biliary tract was 74.3 %. In 74.3 % (55 patients), an ultrasound scan was sufficient to make the correct clinical diagnosis.
Multispiral computed tomography (MSCT) is an indispensable diagnostic method and method for predicting the volume of surgical intervention for malignant neoplasms of the organs of hepatopancreatic zone. MSCT performed in 59 (50 %) patients.
The diagnostic accuracy of MSCT for cholangiocarcinoma of various localization was 91.5 %.
Endoscopic examinations were performed in 31 (26.3 %) patients. Endoscopic retrograde cholangio-pancreatography, based on the results of which, if there are indications for further performance, endoscopic papillosphincterotomy, can be considered the method of choice in the diagnosis and stage-by-stage treatment of obstructive jaundice of gallstone etiology.
Conclusions. In diseases of the biliary tract, complicated by obstructive jaundice, it is first necessary to perform an ultrasound scan. The highest diagnostic accuracy of ultrasound showed in benign diseases, especially with choledocholithiasis — 94.5 %. In case of insufficient information, MSCT should be used. In the presence of X-ray non-contrast calculi, the use of MSCT is impractical, the sensitivity is 80 %. The highest diagnostic accuracy of MSCT was shown for malignant neoplasms of the urinary tract — 91.5 % and is the method of choice in the diagnosis of the prevalence of tumors and its invasion in adjacent anatomical structures and major vessels.
2. Stojko YuM, Levchuk AL, Bardakov VG, Vetshev PS. Vozmozhnosti sovremenny`kh metodov diagnostiki i obosnovanie lechebnoj taktiki pri mekhanicheskoj zheltukhe. Vestnik khirurgicheskoj gastroe`nterolog ii.2008;2:24-32; ISSN: 2072-7984. [In Rus.].
3. Yokoe M, Takada T, Strasberg SM, et al. New diagnostics criteria and severity assessment of acute cholecystit is inrevised Tokyo guidelines. J. Hepatobil. Pancr. Sci.2012;19(5):578-85; PMID:22872303; PMCID: PMC3429769; DOI:10.1007/s00534-012-0548-0;
4. Sikora SS. Management of post-cholecystectomy benignbile duct strictures review. Indian J Surg. 2012 Feb;74(1):22–8; doi: 10.1007/s12262-011-0375-6; PMCID: PMC3259171; PMID: 23372303;
5. Desyaterik VI`, Kotov OV, Shevchenko YeS. Di`agnostika ta li`kuvannya gostrikh uskladnen` zhovchnokam’yanoyi khvorobi na tli` mekhani`chnoyi zhovtyaniczi`. Ukrayins`kij zhurnal khi`rurgi`yi.2014;1(24):140-48. [In Ukr.].
6. Fetyukov AI, Ziginova TM, Ionova LV. Diagnosticheskaya e`ffektivnost` UZI i E`RKhPG pri podozrenii na mekhanicheskuyu zheltukhu. Al`manakh klinicheskoj medicziny.2008;XVII:182-83. [In Rus.].
7. Addlev J, Mitchell RM. Advances in the investigation of obstructive jaundice. Curr. Gastroenterol. Rep.2012;14(6):511-19; PMID:22972453; DOI:10.1007/ s11894-012-0285-1.