RADIATION DIAGNOSTIC METHODS IN THE THERAPEUTIC AND DIAGNOSTIC ALGORITHM FOR MECHANICAL JAUNDICE

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Relevance.Trends of recent decades demonstrate an increase in the number of patients with mechanical jaundice syndrome (MJ) [1]. MF is a syndrome that is observed in various diseases of benign and malignant genesis, causing acute or gradually increasing blockage of the bile ducts (LC)[2]. The problem of diagnosis and treatment of patients with MH is an important medical and social problem that has affected the whole world. Statistics show an increase in the number of patients with LV twice over the past 10 years[3].High-tech diagnostic methods and minimally invasive treatment methods are being introduced into clinical practice, despite this, the issues of timely diagnosis and rational therapeutic tactics still remain unresolved[4]. Goal. The study of the role and place of radiation methods in the therapeutic and diagnostic algorithm and its improvement taking into account possible complications.

Materials and methods. The analysis of the results of treatment of 868 patients with MJ who were treated at the bases of the general surgery clinic "DSMU" for the period from 2000 to the present. The main causes of benign MJ were choledocholithiasis, strictures of the choledochus, chronic pancreatitis, BDS (large duodenal papilla) lesion – 45%, tumor lesions of the periampular zone-55%. 56.3% were female patients, 43.7% were male. MH under the age of 30 was diagnosed in 7.5% of patients, 28.4% under the age of 60, 54% over 60, 10.1% over 80. Mild MH was detected in 24.2% of patients, moderate in 32.5%, severe in 43.3%. The analysis of complications of LV in 37.3% of patients revealed the phenomena of cholangitis, cholangiogenic liver abscesses, signs of liver failure. 72.3% had concomitant diseases (cardiovascular, diabetes mellitus, bronchial asthma, peptic ulcer diseases, etc.)

Upon admission, all patients underwent clinical and laboratory studies (general clinical, biochemical, cancer markers). Instrumental diagnostics (ultrasound, MRI, MRCP, CT, MSCT, FGDS) at the first stage included ultrasound for all patients, and depending on the results obtained, either repeated ultrasound was performed at the second stage, with uninformativity of MRI, MsCT, including contrast, MRCP, FGDS. Depending on the degree of bilirubinemia, one or two-stage treatment was performed. The results were statistically processed using the Statistica 6.0 program. Results. The first-order method of investigation was ultrasound. In 216 cases, cholecystolithiasis was the cause of mechanical jaundice According to ultrasound data, the proximal block of obstruction was detected in 142 cases, the central block in 256 cases, and distal obstruction in 470 cases.In 702 cases, an MRI with 3D reconstruction was performed to detail the localization, extent, and nature of the pathological process. According to the MRI study, obstruction of the proximal level of BT was confirmed in 138 patients. The cause of the proximal level of obstruction in 24 cases was a stricture of benign genesis, and 114-tumors. 28 patients from this group underwent MSCT with contrast to determine vascular invasion and nearby structures. The majority of patients are patients with tumors of the second and third types. Vascular invasion was detected in 12 cases, trifurcation of the LC in 2 patients, bifurcation in 26 patients. Among 156 patients with central block level, the bulk are patients with gallbladder cancer (98) patients). Cholangiocarcinoma was detected in 10 cases, and benign strictures in 48 cases.Distal block was detected in 358 patients. The cause of the distal block in 87 cases were strictures of benign genesis, in 16 cases pancreatic head cysts, and in 254 the cause was tumor formations. Discussion. The sensitivity of ultrasound in determining the presence of obstruction was 94.9%, and the type of obstruction according to Bismuth-Corlette and stricture variations according to the Galperin classification was 46.2%. The sensitivity of MRCPG in detecting the level of location of biliary tract obstruction, Bismuth-Corlette tumor variation and the type of strictures according to Halperin was 98.7%. The sensitivity of MSCT in determining vascular invasion is 88%, and in detecting the prevalence of the tumor process and the variant of confluence formation is 100%. The data were compared with the data of HCHs, RHPG and intraoperative revision data.Ultrasound is a method of primary imaging in a number of diagnostic studies for suspected mechanical jaundice. MSCT with contrast allows to determine the degree of invasion into the pathological process of the vascular structures of the liver gate, the prevalence of the tumor, the presence of metastases and the variant of confluence formation. MRCP allows you to accurately determine the level of occlusion, its extent, the degree of involvement of surrounding tissue and vascular structures and, as a result, determine the volume of the operation, the places of the least traumatic and most informative access to operations. Neither the data of biochemical diagnostic methods nor ultrasound alone or in combination can completely exclude or confirm the presence of obstruction and cannot reveal the nature of obstructive diseases. So, carrying out more than 2 ultrasound visualizations before MRHG and ERCP can lengthen the inpatient stage of treatment by 2-5 days.

Conclusion. Repeated ultrasound at the stage of diagnosis of obstructive diseases of GPDD has low information content. Performing MRCG at the early stages of diagnosis of diseases accompanied by obstruction of the biliary tract leads to a reduction in the time of hospitalization of patients by 2-5 days.

About the authors

Kira L. Seqdalieva

Author for correspondence.
Email: kira_se02@mail.ru
ORCID iD: 0000-0002-4303-7546
Russian Federation, 367000, Russia, Republic of Dagestan, Makhachkala, Lenin Square, 1

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