RU2122352C1 - Method of roentgenologic examination of biliary ducts in patients with manifest bilirubinemia - Google Patents

Abstract

FIELD: X-ray diagnostics of biliary duct diseases. SUBSTANCE: test dose of 1 ml of 70-% adipiodone solution is introduced intravenously 60-70 min before roentgenologic examination. If no side-effects are revealed the remaining solution in volume of 19 ml is introduced. Roentgenograms with shear thickness of 5-10 mm are taken off computer tomograph 30-40 min after X-ray contrast substance is introduced. Use of 70-% solution of adipiodone allows perfecting of indirect method of contrasting of biliary tracts with application of computer tomocholangiography. EFFECT: higher results of examination. 1 cl, 4 dwg, 1 ex

Description

 The invention relates to medicine, in particular to x-ray diagnosis of diseases of the biliary tract in patients with jaundice and can be used as a diagnostic tool in the preoperative period.

 It is known that the existing method of excretory oral or intravenous cholangiography allows contrasting the gallbladder and extrahepatic bile ducts in 80-90% of patients / Jamudilov et al. SU 1711705 A1, A 61 B 6/00 7.03.92 /. However, in patients with severe bilirubinemia, the indirect biliary tract contrast method is completely unsuitable / L.M.Shor et al., 1966. Percutaneous transhepatic cholangiography in biliary tract surgery /.

 The objective of the invention is the improvement of the indirect method of contrasting the biliary tract in patients with severe bilirubinemia using computed tomo-cholangiography, CTCH.

 CTXG method was used as a preoperative diagnostic method in 80 patients with obstructive jaundice and consists in the following: the patient was given a test dose of bilignost / 1.0–70% solution / intravenously 60–70 min before the study. In the absence of side effects, after 15 minutes, the solution remaining in the ampoule (19.0 - 70% bilignost) was administered. After 30-40 minutes from the moment the contrast agent was introduced, images with a slice thickness of 5 and 10 mm were taken on a Philips computed tomograph. In most cases, tomograms showed contrasting of the bile ducts and filling defects with choledocholithiasis. In the studied patients, the bilirubin content in blood plasma ranged from 51 mmol / L to 300 mmol / L. These cases are verified during surgery. Contrasting of the bile ducts did not occur in patients with complete obstruction of the common bile duct, and increased bilirubinemia was not an obstacle for diagnosing calculi of the distal choledochus / Fig. 1, 2, 3, 4 /. Out of 80 patients with jaundice, contrasting occurred in 45; in the rest, the common bile duct was completely obstructed by a stone or tumor.

 Example. Patient R., 72 years old, was admitted to the hospital on March 19, 1992 with complaints of severe pain in the right hypochondrium and epigastrium, dry mouth, and jaundice. She became acutely ill on March 17, 1992 - severe pains appeared in the right hypochondrium, nausea, vomiting, and chills. Paroxysmal pain and previously occurred, but were less pronounced. I strictly followed a diet. From the anamnesis it was found out that in April 1989 a cholecystectomy was performed at another medical institution for gallstone disease. About: condition of the patient of moderate severity, skin and visible mucous membranes of yellow color. The tongue is dry. The abdomen is involved in breathing, painful palpation in the right hypochondrium, a positive symptom of Ortner. There are no peritonial phenomena. In a blood test: white blood cells - 16.7; urea - 9.0; bilirubin - 214 mmol / l, direct - 180 mmol / l; AST - 1.2 and ALT - 2.3. After conservative treatment, the patient's condition improved significantly, abdominal pain subsided, and bilirubin decreased to 131.4 mmol / L. March 24, 1992 was performed by CTCH according to the described procedure / bilirubin in blood plasma - 131.4 mmol / l. /: In the lumen, against the background of contrasting choledochus, a calculus of up to 2 cm in diameter is determined; in the ampullar section - a calculus up to 1.5 cm in diameter. Dz: choledocholithiasis. 03/25/92, the patient was operated on: Kocher laparotomy. The choledoch sharply expanded / up to 3 cm in diameter /. Choledochotomy transversely - up to 70 ml of thick dark bile was poured with flakes and putty, two calculi of 2.3 cm and 1.5 cm in diameter were removed from the lumen. Cholechoduodenoanastomosis according to Kirchner. Drainage tube in the subhepatic space through a puncture in the right lumbar triangle. It was discharged for recovery on April 5, 1992. The concentration of bilirubin in blood plasma upon discharge from the hospital is 31.7 mmol / l.

 Thus, according to the data obtained, pronounced bilirubinemia in patients with jaundice is not an obstacle to the contrast of the biliary tract by computer tomocholangiography.

 The purpose of the invention is to improve the accuracy of diagnosis of choledocholithiasis in patients with increased bilirubinemia.

Claims (1)

 A method for X-ray examination of the bile ducts in patients with severe bilirubinemia by radiography after administration of an intravenous radiopaque substance in the form of a bilignost solution, characterized in that a trial dose of 1 ml of a 70% bilignost solution is administered 60-70 minutes before the study and, in the absence of side effects, it is administered the remaining solution in a volume of 19 ml; after 30-40 minutes from the moment of its introduction on a computer tomograph take pictures with a slice thickness of 5 and 10 mm

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