Роль магнитно-резонансной холангиопанкреатографии в предоперационной диагностике холедохолитиаза у пациентов, готовящихся к лапароскопической холецистэктомии

Abstract

The capabilities of different methods of preoperative diagnostics of choledocholithiasis are considered in the given article. Both routine (transabdominal ultrasound, fibrogastroduodenoscopy and others) and relatively new methods (magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS)) are described from the point of view of their role in solving the problem of timely preoperative diagnostics of choledocholithiasis, as well as the role of intraoperative cholangiography (IOC) in its historical perspective. Particular attention is paid to the informativity of combined application of magnetic resonance cholangiopancreatography and endoscopic ultrasonography in detecting hepatobiliary zone pathology. The role of magnetic resonance imaging (MRI) in detecting hepatobiliary zone pathology and its high accuracy in preoperative diagnostics of choledocholithiasis is emphasized. Current statistical data concerning the use of MRI in the health care system of the Russian Federation are provided in the article. Based on the attained results the authors conclude that the complex of diagnostic program for patients with suspected choledocholithiasis, undergoing laparoscopic cholecystectomy, should include magnetic resonance cholangiopancreatography, besides routine diagnostic techniques. Endosonography should complement magnetic resonance imaging when there is need for updating the diagnosis. Retrograde cholangiopancreatography should be used in case of uninformative magnetic resonance cholangiography and endoscopic sonography. This approach improves considerably the diagnostic accuracy of studies and reduces the number of invasive diagnostic procedures. Key words Сholedocholithiasis, magnetic resonance сholangiopancreatography (MCRP), magnetic resonance imaging (MRI), endosonography (EUS), laparoscopic cholecystectomy, mini-invasive technologies