The COURSE the ANGIOGRAPHY (Greek chole bile - | - apgeion a vessel + grapho to write, represent) — a method of X-ray inspection of bilious channels after direct administration of radiopaque substance in them.
Fig. 1. A transdermal transhepatic ho-lapgpografiya at cholelithiasis (a direct projection): bilious channels (1) and the general bilious channel (2) are expanded, in a distal part of the general bilious canal there is an okklyuziruyushchy stone (3).
In a crust, time four ways holangiogra-fip have distribution: endoscopic retrograde pankreatokholangiografiya, transdermal transhepatic holangiogra-fiya, intraoperative and postoperative holangiografiya.
An endoscopic retrograde pankreatokholangiografiya (see. A punk
re that x about l of cut of but r and f and I retrograde) make in the presence of the cholestasia established on a wedge, to symptoms and data of a holestsintigrafiya (see Holegrafiya) or ultrasound examination of a liver. The method allows to differentiate hepatocellular and mechanical jaundice, to find stones in bilious ways, to reveal tumoral defeat of bilious channels (see. Bilious heat), and in some cases to find out the reason p OST .gol e-tsistekt an ohmic syndrome (see). This way of a holangiografiya gives the chance at the same time to study pancreat ducts and to examine a duodenum. At a neobkhodikhmost through duodenoskop the biopsy, a sphincterotomy and removal of a stone from the general bilious channel, long catheterization of the general bilious channel for the purpose of drainage or administration of medicines can be made. Contrasting of bilious ways works well at this way of a holangiografiya at 80 — 90% of patients.
The transdermal transhepatic holangiografiya gained distribution when there were superfine needles for a puncture of intra hepatic channels ensuring access
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bilious ways. The main indications — specification of localization, the nature and character of occlusion of bilious channels at patients with the jaundice caused by a stone, a stricture, a tumor when carrying out a retrograde holangiografiya is impossible. Contraindications — a purulent cholangitis, hemorrhagic diathesis, sharp disturbances of coagulant system of blood. After premedication (see the Anaesthesia) and local anesthesia (see. And a nesteziya local) make a transdermal puncture of an abdominal wall in the eighth mezhreberye on the front axillary line. If bilious canals are expanded that they establish previously by means of a computer tomography (see the Tomography computer) or ultrasonic scanning (see. Ultrasonic diagnosis), the needle is sent to peripheral departments of a liver; at not expanded channels — towards portal fissures. The puncture of expanded channels works well almost always, and not expanded — at 80 — 85% of patients. Under control of X-ray television (see Television in medicine) the end of a needle is established in a gleam of one of intra hepatic bilious channels and on it enter necessary amount (from 20 to 60 ml) of triyodirovan-ny radiopaque substance (see), after that make roentgenograms in a straight line and slanting projections (fig. 1). The terminal part of the general bilious canal is investigated in vertical or poluvert flax position of the patient. The procedure of diagnostic testing can pass in medical if expanded bilious channels are found and there are indications to their temporary or constant drainage. If at detection of hypertensia of bilious channels their drainage is at once carried out, then complications are observed seldom. Treat them: the expiration of bile or blood in an abdominal cavity, a hemobilia (see), accidental wound of bodies of a chest or abdominal cavity. For prevention of septic complications introduction of antibiotics in 1 hour prior to the procedure and after it is recommended.
The intraoperative holangiografiya is offered P.L.Mi-rizzi in 1931. It is carried out on the operating table after opening of an abdominal cavity. Carrying out an intraoperative holangiografiya demands accurate interaction of the surgeon and the radiologist. Indications to this look the same holangiografiya, as to a surgical research of bilious channels. There are no absolute contraindications, and relative are an acute cholangitis and tya
an inhabited condition of the patient, at to - r about m me swarms r to five I about r Onitsha va yut-sya operation of removal of pus and bile. The intraoperative holangiografiya allows to find out a condition of bilious channels and to avoid a choledochotomy (see) approximately at a half of patients, the Crimea is made by operations on the bilious ways. Int-r and about and eratsionny x about l and N of and about r and f and yu
carry out in the operating room equipped with X-ray equipment with the three-phase generator; the X-ray television research and the video magnetic record are combined with a survey X-ray analysis. Holangiogra-fiya is recommended to be made prior to a tool research of bilious channels. Apply divorced (30 — 50%) solutions of radiopaque substances that in an intensive shadow of channels even small stones (fig. 2) were visible. Radiopaque substance is entered preferential through a vesical channel or directly into the general bilious canal, in the beginning
5 — 8 ml with a low pressure and carry out the first picture, and then 10 — 15 ml under pressure then make the second picture. At correctly conducted research of complications it is not observed.
The postoperative holangiografiya serves for assessment of results of an operative measure for the purpose of identification of the remained gallstones (fig. 3), postoperative strictures of channels, definition of passability of artificially created anastomosis between bilious pu-
of Fig. 2. An intraoperative holangiografiya at cholelithiasis (a direct projection): the general bilious channel (1) is expanded, in its distal part the group of stones (2), a contrast agent leaves (3) in a duodenum; in the general bilious channel the catheter is visible.
Fig. 3. A postoperative chrezzoidovy holangiografiya at cholelithiasis (a direct projection): via the probe (i) intra-hepatic and extrahepatic bilious channels are filled with a contrast agent, in distal department of the general bilious channel the defect of filling caused by a stone (2) is visible.
tyam also went. - kish. a path, for a research of spontaneously arising outside and internal bilious fistulas. Through the drainage tube or a catheter left later to operation or through fistula, under control of roentgenoscopy slowly enter
25 — 50% solution of triyodirovanny radiopaque substance. Changing position of the patient, a dobiva
fillings of the departments of bilious ways interesting the doctor yutsyatsya.
If necessary administer the medicines causing relaxation or a spasm of a sphincter of Oddi (a sphincter of the general bilious channel) and at the same time contrast a stomach or a duodenum. Complications at a postoperative holangiografiya do not arise if the technique of a research was not broken.
See also Holegrafiya.
Bibliography: Blagovidov D. D.
, etc. Endoscopic pankreatokholangiografiya, Owls. medical, No. 3, page 36, 1976; Lindenbraten L. D. Radiology of a liver and bilious ways, M., 1980; Lindenbraten L. D. and Naumov L. B. Methods of X-ray inspection of bodies and systems of the person, Tashkent, 1976; Milonov O. B., And with t r about N and to about in Yu. V. Is also old and - to about in and V. B. Outside transhepatic drainage of hepatic and bilious channels, Surgery, No. 10, page 131, 1978;
Anacker H., Weiss H. D. and. Kgayuapp V. of Endoscopic retrograde nancreaticocholangiography (RPC), V., 1977; Hoevels J. Ergebnisse der per-kutanen transhepatischen Portographie, Fortschr. Rontgenstr., Bd 128, S. 432, 1978; Muller P. R. a. o. Fine-needle transhepatic cholangiography, Amer. J. Roentgenol., v. 136, p. 85, 1981; About i I., Kobayashi S. Kondo T. Endoscopic pancreatocholangiography,
En doscopy, v. 2, p. 103, 1970; About
k u-d a K. Radiological aspects of the liver and biliary tree, Tokyo, 1976.
L. D. Lindenbraten.