cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2019-34-3-161-171cardiotomsk-828Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESСовременные методы лучевой диагностики заболеваний, сопровождающихся синдромом механической желтухиModern imaging modalities for diseases associated with obstructive jaundice syndromehttps://orcid.org/0000-0001-5986-1030ЗарубинВ. В.ZarubinV. V.

аспирант кафедры лучевой диагностики и лучевой терапии,

634050, Томск, Московский тракт, 2

аспирант кафедры лучевой диагностики и лучевой терапии,

2, Moskovsky tract, Tomsk, 634050

Vladislav.zrb@gmail.comhttps://orcid.org/0000-0003-1316-5421КуражовА. П.KurazhovA. P.

д-р мед. наук, профессор кафедры лучевой диагностики и лучевой терапии,

634050, Томск, Московский тракт, 2

д-р мед. наук, профессор кафедры лучевой диагностики и лучевой терапии,

2, Moskovsky tract, Tomsk, 634050

kurazhovap@mail.ruhttps://orcid.org/0000-0001-6231-7650ЗавадовскаяВ. Д.ZavadovskajaV. D.

д-р мед. наук, профессор, заведующий кафедрой лучевой диагностики и лучевой терапии,

634050, Томск, Московский тракт, 2

д-р мед. наук, профессор, заведующий кафедрой лучевой диагностики и лучевой терапии,

2, Moskovsky tract, Tomsk, 634050

wdzav@mail.ruРодионоваО. В.RodionovaO. V.

канд. мед. наук, врач-рентгенолог отделения томографических методов исследования,

 

Cand. Sci. (Med.), Radiologist, Department of Tomographic Methods of Study,

2, Moskovsky tract, Tomsk, 634050

ТонкихО. С.TonkikhO. S.

канд. мед. наук, заведующий отделением томографических методов исследования,

634050, Томск, Московский тракт, 2

Cand. Sci. (Med.), Head of the Department of Tomographic Methods of Study,

2, Moskovsky tract, Tomsk, 634050

КлиновицкийИ. Ю.KlinovitskiyI. Ju.

канд. мед. наук, врач-хирург, заведующий клиникой общей хирургии,

634050, Томск, Московский тракт, 2

Cand. Sci. (Med.), Surgeon, Head of the General Surgery Department, 

2, Moskovsky tract, Tomsk, 634050

Сибирский государственный медицинский университет Министерства здравоохранения Российской ФедерацииРоссияSiberian State Medical UniversityRussian Federation201904112019343161171Copyright © Зарубин В.В., Куражов А.П., Завадовская В.Д., Родионова О.В., Тонких О.С., Клиновицкий И.Ю., 20192019Зарубин В.В., Куражов А.П., Завадовская В.Д., Родионова О.В., Тонких О.С., Клиновицкий И.Ю.Zarubin V.V., Kurazhov A.P., Zavadovskaja V.D., Rodionova O.V., Tonkikh O.S., Klinovitskiy I.J.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/828

Механическая желтуха (МЖ) – синдром, характеризующийся желтушным окрашиванием кожных покровов, слизистых оболочек и склер, являющийся осложнением патологических процессов, приводящих к нарушению оттока желчи на различных уровнях желчевыводящих путей. МЖ представляет собой совокупность различных заболеваний, имеющих различное начало, течение и исход, а также этиологию, что указывает на трудности диагностического процесса. Выявление причины холестаза и лечение пациентов с синдромом МЖ остается актуальной и трудно решаемой задачей клинической медицины в силу неуклонного роста заболеваний гепатопанкреатодуоденальной зоны (ГПДЗ) и высокой частоты диагностических ошибок. Последние могут привести к возникновению и прогрессированию печеночной недостаточности, а также развитию тяжелых осложнений, которые, в свою очередь, могут стать причиной летального исхода. Значительная роль в выявлении патологии ГПДЗ принадлежит лучевым методам исследования, таким как трансабдоминальное ультразвуковое исследование (ТАУЗИ), эндоскопическая ретроградная холангиопанкреатография (ЭРХПГ), чрескожно-чреспеченочная холангиография (ЧЧХГ), эндоскопическое ультразвуковое исследование (ЭУС), интрадуктальная ультрасонография (ИДУС), магнитно-резонансная холангиопанкреатография (МРХПГ), спиральная компьютерная томография (СКТ), а также СКТ-холангиография (СКТ-ХГ). Вместе с тем следует отметить, что на сегодняшний день не существует устоявшегося общепринятого лучевого алгоритма, использующегося в определении причин билиарной обструкции. А это, в свою очередь, приводит к многократному или последовательному неэффективному использованию всех возможных методов визуализации, усложняя диагностический алгоритм. В связи с этим целесообразно углубленное изучение отечественных и зарубежных литературных источников, освещающих проблему ранней и высокоэффективной диагностики причин билиарной обструкции у пациентов с МЖ.

Obstructive jaundice (OJ) is a syndrome characterized by bile staining of the skin, mucous membranes, and sclera as a complication of pathological processes that lead to disruption of the bile ducts at various levels of the biliary tract. Obstructive jaundice represents various diseases with different onset, course, and outcome, as well as etiology, which implies the difficulties of the diagnostic process. Identification of a cholestasis cause and treatment of patients with OJ remain urgent and difficult tasks due to the steady rise in diseases of the hepatopancreatoduodenal zone (HPDZ) and the high frequency of diagnostic errors. The latter can lead to the progression of liver failure, as well as to the development of severe complications, which, in turn, are fatal. A significant role in detecting HPDZ pathology belongs to the radiological methods of studies, such as transabdominal ultrasonography (TUS), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical computed tomography (hCT), and helical CT cholangiography (hCT-CG). However, it should be noted that, as of today, there is no well-established conventional radiological algorithm for determining the causes of biliary obstruction. This, in turn, leads to repeated or sequential inefficient administration of all possible methods of visualization, complicating the diagnostic algorithm. In this regard, it is advisable to perform an in-depth study of the Russian and foreign literature sources, highlighting the problem of an early and highly effective diagnostics of the causes of biliary obstruction in patients with OJ.

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The authors declare that there are no conflicts of interest present.