HOLANGIOMANOMETRIYa (Greek chole bile + angeion a vessel + manos rare, leaky + metreo to measure, measure) — an intraoperative method of determination of pressure in bilious channels.
For the first time experiments on tonometry in bilious channels were made in 1868 by Geydengayn. In 1935. I. I. Orlov for the first time measured pressure in bilious ways to time of surgery. J. Caroli in 1939 and Malle-Gui (R. of Mallet-Guy) in 1942 developed a rentgenomanometriya (a manomet-riya of bilious ways under control of an operational holangiografiya).
In our country this technique was rather widely used
by V. V. Vinogradov, I. B. Rozanov,
3. A. Tskhakaya, 0. I. Galperin and DR-
the Method is applied at operations on bilious channels (see) for the purpose of identification of their functional or organic changes. The data on build-up of pressure obtained at the same time confirm disturbance of outflow of bile, allow to reveal extent of these disturbances, but do not open their reason.
For carrying out a holangiomano-metriya use the water manometer (see) or the device for measurement of venous pressure (see. Blood pressure). E. I. Galperin with sotr. (1964) suggested to use for this purpose a simple manometrical tube with a tee (length of a tube shall be 600 — 700 mm, and its
diameter not less than 4 — 5 mm).
The cannula to the general bilious canal is carried out through a stump of a vesical channel after a cholecystectomia (see) or after its puncture a needle. Before a research in sterile conditions fill a tank (flask) with the isotonic solution of sodium chloride which is warmed up to body temperature and fill with it all system, paying special attention to lack of air traps. At installation of the manometer take the level of the general bilious channel for zero level. Then (before administration of liquid) measure initial pressure, a cut normal in a gall bladder usually makes 50 — 100 mm w.g., in the general bilious channel — 30 — 50 mm w.g. After that bilious channels gradually fill with isotonic solution of sodium chloride, registering at the same time filling pressure. Filling of bilious channels and gradual increase in pressure in them leads to passing of liquid to a duodenum. The minimal pressure necessary and resistance of a sphincter, sufficient for overcoming, call pressure of passing. Normal in the general bilious channel it fluctuates from 100 to 180 mm w.g. As soon as passing of liquid through a sphincter is noted, forcing of liquid to bilious canals is stopped and during their emptying register pressure of evacuation. After all liquid moved to a duodenum, in bilious channels measure residual pressure, a cut is normal on 40 — 60 mm w.g. lower than pressure of passing. In order to avoid a mistake all specified measurements repeat 3 — 4 times. The greatest practical value has residual pressure, and in a crust, time most of surgeons during a holangiomanometriya define only this indicator.
Pressure in bilious ways is estimated as raised, lowered or normal. Hypertensia of bilious channels is caused by the partial or their full obstruction caused by stones, strictures, tumors, etc. Hypotension meets at nekalkulez-number cholecystitis, insufficiency of a faterov of a nipple (a big nipple of a duodenum, T.), diye-kinesias of bilious ways. At patol. the changes which are not leading to disturbance of a tone, motility and hydrodynamics of bilious ways normal indicators of pressure can be observed.
Independent value of a holangiomanometriya is very limited, its results shall be supplemented surely with data of a holangiografiya (see) and Holedokhoskopii (see).
Bibliography: Vinogradov V. V.
Faterov's diseases pacifier, M., 1962;
Vinogradov V. V., M and z and e in P. N. and r and sh to e in and the p E. B. X-ray manometrical research of bilious ways, L., 1966; In and sh N e in -
with to and y A. A., r and sh to e in and the p E. Century and Sark and with about in D. S. Chronic calculous cholecystitis and its surgical treatment, M., 1967; Hectare of l p e-
r and E. I. N and About with t r about in with to and I am I. M. A contrast research in surgery of bilious ways, M., 1964; With and t e N -
to about V. M. and Not h and y A. I. Postkhole-tsistoktomichesky a syndrome and repeated operations on the bilious ways, L., 1972.
V. P. Glabay, G. B. Katkovsky.