Abstract
Objective . To determine the need and role of transpapillary endoscopic interventions in acute cholecystitis complicated by the main bile ducts pathology based on refined diagnostics using modern radiology examination methods. Materials and methods . The experience of treatment of 1137 patients operated on for acute cholecystitis during the last three years was analyzed. A differentiated approach for the use of highly informative methods of radiology diagnostics was based on clinical, anamnestic, laboratory and ultrasound data. In the selected groups of increased risk of bile duct pathology, endoscopic ultrasonography and magnetic resonance cholapgiopancreatography were used to clarify the diagnosis. The need for these studies was substantiated in 23.4% of cases. Based on the data obtained, indications for minimally invasive interventions aimed at decompression and correction of pathological changes in the biliary tract were formulated. They were performed in 182 (16%) patients, mainly by the endoscopic transpapillary route. Results. The need for a detailed assessment of clinical, laboratory, and ultrasound data is shown, indicating a possible biliary tract pathology and justifying the use of high-tech methods of radiology diagnosis. The options of decompression interventions, their rational sequence and combinations in acute cholecystitis complicated by bile ducts pathology are considered. Attention is focused on the need for careful monitoring of the effectiveness of interventions with a view to timely correction. Using the proposed diagnostic and treatment algorithm, the mortality rate was 0.26%. Conclusion . In acute cholecystitis, a detailed assessment of clinical, laboratory, and ultrasound data allows us to identify the “alarming” symptoms of a possible bile ducts pathology. These patients require an in-depth assessment of the state of the biliary tract using high-tech non-invasive diagnostic methods — endoscopic ultrasonography or magnetic resonance cholangiopancreatography. The detected changes (choledocholithiasis, stenosis of large papilla of the duodenum) should be eliminated by endoscopic transpapillary interventions as the first stage of treatment before removal of the gallbladder.
Highlights
Они выполнены 182 (16%) больным, преимущественно эндоскопическим транспапиллярным путем
A differentiated approach for the use of highly informative methods of radiology diagnostics was based on clinical, anamnestic, laboratory and ultrasound data
In the selected groups of increased risk of bile duct pathology, endoscopic ultrasonography and magnetic resonance cholapgiopancreatography were used to clarify the diagnosis. The need for these studies was substantiated in 23.4% of cases
Summary
The experience of treatment of 1137 patients operated on for acute cholecystitis during the last three years was analyzed. A detailed assessment of clinical, laboratory, and ultrasound data allows us to identify the “alarming” symptoms of a possible bile ducts pathology These patients require an in-depth assessment of the state of the biliary tract using high-tech non-invasive diagnostic methods – endoscopic ultrasonography or magnetic resonance cholangiopancreatography. Первый – трехэтапный: выполнение срочной декомпрессии желчного пузыря под контролем УЗИ или лапароскопии и затем после ликвидации воспаления – фистулографии и при необходимости эндоскопического вмешательства на магистральных желчных протоках с последующей холецистэктомией (ХЭ). Вместе с тем высокая стоимость и определенная сложность выполнения и интерпретации результатов в ряде ситуаций служат причиной для отказа от этих методов дооперационной оценки желчных путей и объяснением повышения маркеров холестаза другими транзиторными причинами, такими как воспалительно-инфильтративные изменения в желчном пузыре, печеночная недостаточность, миграция микролитов и т.д. Цель исследования – определить необходимость и роль транспапиллярных эндоскопических вмешательств при остром холецистите, осложненном заболеваниями магистральных желчных протоков, на основе уточненной диагностики с применением современных лучевых методов исследования
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