Nakashidze M. Diagnosis and treatment of atypical and asymptomatic choledocholithiasis

The thesis is devoted to solving scientific problems which provide improved results of surgical treatment of atypical and asymptomatic choledocholithiasis, based on improved methods of diagnosis and choice of methods miniinvasive surgery. Analysis of clinical data and laboratory studies made it possible for the most important symptoms and indicators for choledocholithiasis. Research were 102 patients with choledocholithiasis (69 with atypical and 33 with asymptomatic) - the main group and 50 patients with gallstone disease, but without choledocholithiasis. Based on the analysis of survey results showed that the main clinical signs of choledocholithiasis - pain, jaundice and fever occur less frequently with atypical, and are rarely observed in asymptomatic choledocholithiasis than the typical course of choledocholithiasis. It is proved that only in 32 (31,4%) patients had direct ultrasound signs of choledocholithiasis. To verify concrements common bile duct, we proposed a new noninvasive method for diagnosing magnetic-resonance cholangiopancreatography.This method we conducted in 42 patients with suspected bile duct stones. Stones were diagnosed in 41 (97,6%) patients. The method of noninvasive, requires no contrasting has no radiation exposure and is not accompanied by complications. The sensitivity is high not only in concrement diameter of 5-10 mm and greater than 10 mm (100 % in both cases), but at a diameter of 5 mm - 94,4% with average accuracy of 97.6% and does not depend on diameter of the common bile duct. Sensitivity magnetic resonance cholangiopancreatography significantly higher than ultrasound - 97, 6% and 31,3%, respectively, and comparable to the value of endoscopic retrograde cholangiopancreatography - 96,7%. Comparison of two-stage method of treatment with a one-stage showed that the more promising is a one-stage minimal access surgical intervention. With this intervention there is no risk of complications, which is accompanied by endoscopic retrograde cholangiography + papilosphincterotomy.