HOLEDOHOSKOPYYa [lat. (ductus) of choledochus a bilious channel + Greek skopeo to observe, investigate; a synonym a holangioskopiya] — an endoscopic research of bilious channels.
For the first time the holedokhoskopiya during operation is made in 1908 by Beyk-com(J. Bakes)). H. Wilde-gans in 1953 offered for this purpose the endoscope (see Endoscopy, endoscopes) supplied with irrigational system and a tiny bulb on the distal end. Creation of rigid and flexible holedokhoskop with use of a fiber optics (see Fiber glass, use in medicine) and powerful sources of bright «cold» light allowed to examine all extrahepatic bilious channels from within (see) and intra hepatic — to 2 — the 3rd order. The holedokhoskopiya gained further development after creation superthin (apprx. 2 mm in the diameter) holedokhoskop, to-rye can be entered into a gleam of bilious and pancreatic channels during a duodenoskopiya via the channel of a duodenoskon — a so-called transduodenal iankreatokholangiosko-piya.
Indications to use of a hole-dokhoskoiiya are suspicion on the occlusive or stenosing defeat of the main bilious
Fig. 1. Holedokhoskop e a fiber light guide of XBC-I with the lighter: 1 — the stationary lighter; 2 — a fiber light guide for leading of light from the lighter to a holedokhoskop, 3 — an eyepiece; 4 — the crane of system of supply of wash liquid; 5 — a tubular knee a holedokho-osprey, 6 — an operational sleeve of a working knee, 7 — the flexible tool.
channels (stones, a tumor, a cicatricial stenosis), and also need of removal of concrements, is more rare — sections of a faterov of a nipple (a big nipple of a duodenum, T.). Contraindications to a holedo-hoskopiya are narrowing of a gleam of bilious channels (to dia. less than 6 mm), sharp thinning and fragility of their walls. Existence of a purulent cholangitis (see) or acute pancreatitis (see) demands at a research of extra care.
For a research use rigid or flexible holedokhoskop. The design of rigid and flexible holedokhoskop allows to sterilize all their parts.
Rigid holedokhoskop (fig. 1) consists of two tubular knees connected among themselves at an angle 120 or 90 °. Inside holedokhoskop and there is a lens optical system. The short distal knee is entered into the general bilious canal. Previously put on protective sleeves this knee, through to-rye carry out flexible tools: kelectomes, baskets for extraction of foreign bodys or stones, balloon catheters, etc.
In a flexible holedokhoskop for transfer of light from the stationary lighter and the image the fiber optics is used. The distal part of such endoscopes entered into the canal, flexible and managed (fig. 2).
Holedokhoskopiya is made during operation after filling of bilious channels with physiological solution; at a cholangitis add antibiotics or antiseptic agents to it. Holedokhoskop it is reasonable to enter through a supraduodenalny ho-ledokhotomichesky opening (see the Choledochotomy). In the beginning examine hepatic and intra hepatic channels, then — the general bilious
Fig. 2. Holedokhoskop biopsy with a fiber optics of HOB-VO-1: 1 — a fiber light guide for leading of light from the stationary lighter; 2 — an eyepiece; 3 — the handle of management of a bend of the distal end; 4 — the flexible tool; 5 — a nozzle; 6 — a branch pipe with the crane for supply of wash liquid and introduction of the flexible tool; 7 — a flexible part;
8 — the managed distal part.
channel. For detailed survey of bilious channels change the provision of the distal end of the endoscope by means of the lever handle. Carrying out the device forward and slowly taking it, the surgeon fingers of the left hand korrigirut the provision of the distal end of the endoscope in a channel. After survey of bilious channels, according to indications, make a biopsy, extraction of stones, the directed washing of channels, is more rare — their bougieurage and a papillo-tomiya (see Faterov than pacifiers).
The mucous membrane of not changed bilious channels at a holedokho-skopiya is represented grayish-pink, sometimes with a yellowish shade (tsvetn. tab., Art. 112, fig. 1). A mucous membrane of vnutripeche-night channels of lighter shade with slightly corrugated surface; the mucous membrane of the general bilious channel is painted more brightly and more friable.
At a catarral cholangitis (see) find a hyperemia and hypostasis of a mucous membrane of bilious channels, places — petekhialny hemorrhages. At a fibrinous cholangitis on an edematous mucous membrane drain hemorrhages, in a gleam of channels — muddy bile with flakes of fibrin are visible. At a fibrinous and ulcer cholangitis extensive hemorrhages, erosion, fibrinous imposings come to light (tsvetn.tabl., Art. 112, fig. 2). At it is purulent - a necrotic cholangitis the large ulcers and the centers of a necrosis passing to a submucosal layer are visible; dense pus in a gleam of channels.
The endoscopic picture at stones of bilious channels is characteristic (see Cholelithiasis). Most often bright yellow cholesteric stones meet (tsvetn. tab., Art. 112, fig. 4). They are quite soft, easily crumble at contact with the endoscope. Pigmental stones dark, usually not pain
of the shy size, firm (tsvetn. tab., Art. 112, fig. 3). The mixed stones have more dark shade, often fasetchaty form, more dense consistence. Floating stones
in bilious channels usually are found without effort; the stones
fixed in vnutripechenoch-
ny channels in a distal part of the general bilious canal or in its divertikuloobrazny expansions, come to light at careful methodical survey of these departments of channels.
Exophytic tumors of bilious
channels (see. Bilious channels,
tumors) at a holedokhoskopiya have an appearance of a cauliflower, white, pink or grayish coloring. Less bright holedokhoskopichesky picture is noted at the endophytic stenosing tumors, to-rye are characterized by unusually white or gray coloring of a mucous membrane of a channel. The diagnosis is specified at gistol. research of biopsy material.
At a stenosis of a faterov of a nipple note its puffiness, a hyperemia, fibrinous imposings, vicious hands. At pancreatitis (see) by means of a holedokhoskopiya sometimes find narrowing of terminal department of the general bilious channel throughout 2 — 3 mm. The accurate endoscopic signs allowing to distinguish this narrowing from a prelum of a channel at a pancreatic cancer no.
In recent years in connection with development of the endoscopic equipment ho-ledokhoskogshyu began to carry out at a duodenoskopiya superthin endoscopes (see Endoscopy).
Complications at a holedokhoskopiya (an injury of bilious channels, acute pancreatitis) meet seldom and are connected generally with disturbances of the technique of a research.
Bibliography: Blagov and Dov D. F.
, etc. Operating room! diagnosis of a cholangiolithiasis, Surgery, No. 4, page 25, 1979; Peas JI. And. and Khokhlova H. M. Features of the device and a technique of use of a holedokhoskop with a fiber light guide of HVS-1, the Medical technician, No. 4, page 55, 1975; Also the l about in M. V. and d Is given to river. Operational holangioskopiya, Vestn. hir., t. 121, No. 7, page 122, 1978; M. I. Cousins and d river. Operational holangioskopiya, Tashkent, 1983; M and l it about in O. B. and Timoshin A. D. A complex research during operations on the bilious ways, M., 1981; Panche of N to about in R. T., Lezhnev A. N. and Ivanov V. R. Clinical use of an advanced design of an operational fotokholedokhoskop, Surgery, No. 10, page 76, 1975, bibliogr.; Khokhlova N. M., M about l e in And. And. and H and h e the N to about in V. A. Holedokhoskop with a fiber light guide, Is new. medical instrument making, century 1, page 12, 1973; To a w an i K. and. Eine neue endoskopische Technik, Die perorale Choledocho-Pankreatikosko-pie, Leber, Magen, Darm, Bd 6, S. 121, 1976; Rosch W., Koch H. a. D e-m 1 i n g L. Peroral cholangioscopy, Endoscopy, v. 8, p. 172, 1976; S t 6 t t e r L., W i e n d 1 H. - J. a. U 1 t s with h B. An improved flexible cholangioscope, ibid.,
v. 7, p. 150, 1975; U r a k a m i Y. o. Peroral direct cholangioscopy (PDCS) using routine straight-view endoscope, ibid., v. 9, p. 27, 1977; W ij degans H.
Endoskopie der tiefen Gallenwege, Langen-becks Arch. klin. Chir., Bd 276, S. 652, 1953.
M. V. Danilov; H. M. Khokhlova (tekhn.).