Novosti
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Year 2011 Vol. 19 No 6
GENERAL AND SPECIAL SURGERY
B.D. BOBOEV, F.I. MAKHMEDOV, B.A. IKROMOV
MINIMALLY INVASIVE METHODS IN DIAGNOSTICS AND TREATMENT OF CHOLEDOCHOLITHIASIS
Objectives. Improvement of diagnostics and treatment results of cholelithiasis, complicated by choledocholithiasis on the basis of complex application of contemporary highly informative non-invasive investigation methods and to determine advantage of minimally invasive operative methods
Methods. Examination results of 86 patients in whom choledocholithiasis was suspected during the period of 2005 to 2009 served as the basis of this research. Male patients composed 9 (10,5%) and female - 77 (89,5%); the age of the examined patients varied from 25 to 87 (the average age 67,3±12,0 years). Patients over 60 composed 48 (55,8%) of the total number of patients. As the result of the complex examination the concrements of extrahepatic bile ducts were revealed in 63 patients; in 4 of these patients – residual choledocholithiasis and combination of choledocholithiasis with Mirizzi syndrome (MS) – in 6 patients.
Results. According to our observations, magnetic resonance cholangiopancreatography (MRCP) appeared to be the most informative method of investigation of the bile ducts permitting to determine the definite cause and disturbances degree of their passability. This investigation method was applied in 34 patients (39,5%) on the tomography with magnetic field 1.5 T. MRCP permitted to verify the stones in the bile duct in 31 patients and in non-dilated general bile duct – in 8 patients. The multiple (2 to 5) concrements in the common bile duct (CBD) were revealed in 19 cases including its distal section – in 11 patients. Minimally visualizing size of the concrements was 2 mm.
Conclusions. MRCP method efficacy in choledocholithiasis diagnostics made up 98,5%. MRCP application permitted to verify diagnosis with high degree of reliability, to determine pathological process prevalence, to choose optimal operative technique and to avoid various complications development accompanying invasive diagnostics interventions.
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