Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical SurgeryВестник экспериментальной и клинической хирургии2070-478X2409-143XVoronezh State Medical University named after N.N. Burdenko16810.18499/2070-478X-2015-8-1-92-99Original articlesОригинальные статьиUnknownN.B. Role of Magnetic Resonance Cholangiopancreatography in Preoperative Diagnostics of Choledocholithiasis in Patients Undergoing Laparoscopic CholesyctectomyN.B. Роль магнитно-резонансной холангиопанкреатографии в предоперационной диагностике холедохолитиаза у пациентов, готовящихся к лапароскопической холецистэктомииKashchenkoV.A.КащенкоВ.А.

MD, Prof., Chief of Department of Departmental Surgery, Director of Surgical Service of CH №122; Faculty of Medicine

д.м.н., проф., руководитель хирургической службы КБ № 122. Медицинский факультет, кафедра факультетской хирургии, заведующий кафедрой

author@vestnik-surgery.comLoitА.АЛойтА.А

MD, Prof., Chief of Department of Departmental Surgery, Faculty of Medicine CH №122

д.м.н., проф., медицинский факультет, кафедра факультетской хирургии КБ № 122

author@vestnik-surgery.comSolonitsynE.G.СолоницынЕ.Г.

Ph.D., Assoc. Prof., Faculty of Medicine, Department of Departmental Surgery, CH №122, Endoscopist

к.м.н., доц., медицинский факультет, кафедра факультетской хирургии КБ № 122, врач-эндоскопист

author@vestnik-surgery.comLukichevR.I.ЛукичевР.И.

Post-graduate student of Faculty of Medicine, Department of Departmental Surgery

аспирант медицинского факультета, кафедра факультетской хирургии

sapientia83@mail.ruSkul'skiiS.K.СкульскийС.К.

Post-graduate student, CH №122, radiologist of MRT office. Mechnikov North-West State Medical University, Department of Radiology

КБ № 122, врач-рентгенолог кабинета МРТ. Аспирант СЗГМУ им. И.И. Мечникова, кафедра лучевой диагностики

author@vestnik-surgery.comLebedevaN.N.ЛебедеваН.Н.

Post-graduate student, CH №122, surgeon. Faculty of Medicine, Department of Departmental Surgery CH №122

КБ № 122, врач-хирург. Аспирант медицинского факультета, кафедра факультетской хирургии КБ № 122

author@vestnik-surgery.comSaint-Petersburg State University, 8a V.O. 21st Line., Saint-Petersburg, 199106, Russian FederationСанкт-Петербургский государственный университет, В.О., 21-я линия, д.8а, Санкт-Петербург, 199106, Российская Федерация240320158192992704201627042016Copyright ©; 2015, ., ., ., ., ., .Copyright ©; 2015, Кащенко В., Лойт А., Солоницын Е., Лукичев Р., Скульский С., Лебедева Н.2015., ., ., ., ., .Кащенко В., Лойт А., Солоницын Е., Лукичев Р., Скульский С., Лебедева Н.http://creativecommons.org/licenses/by-nc-nd/4.0https://vestnik-surgery.com/journal/article/view/168

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

Статья основана на материале исследований отечественных и зарубежных хирургов, эндоскопистов и лучевых диагностов, посвященному наиболее распространенному осложнению лапароскопической холецистэктомии - резидуальному холедохолитиазу. В статье рассмотрены диагностические возможности различных методов исследования, включая рутинные (трансабдоминальное ультразвуковое исследование, фиброгастродуоденоскопия) и относительно новые, такие как магнитно-резонансная холангиопанкреатография (МРХПГ) и эндоскопическая ультрасонография (ЭУС) в решении проблемы своевременной дооперационной диагностики холедохолитиаза, а также роль интраоперационной холангиографии (ИОХГ) в историческом аспекте и практическом применении. Особое внимание уделено информативности комплексного применения магнитно-резонансной холангиопанкреатографии и эндоскопической ультрасонографии в выявлении патологии гепатобилиарной зоны.На основании полученных результатов авторы приходят к выводу о том, что комплекс диагностической программы пациентов с подозрением на холедохолитиаз и планируемой лапароскопической холецистэктомией, помимо рутинных методов исследования, должен включать магнитно-резонансную холангиопанкреатографию. Эндосонография должна дополнять магнитно-резонансную томографию в случае необходимости уточнения диагноза. Ретроградная холангиопанктреатография должна использоваться при неинформативности магнитно-резонансной холангиографии и эндоскопической сонографии. Такой подход значительно повышает диагностическую точность исследований и снижает количество инвазивных диагностических манипуляций, что приводит к уменьшению частоты развития осложнений, сокращению сроков госпитализации и экономических затрат.

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