Gubanov D. Optimization of ultrasonic diagnosis and minimally invasive treatment of ligature fistulas

This research is devoted to the increasing effectiveness of diagnosis and treatment of ligature fistulas. Ways to optimize ultrasound examination of ligature fistulas were developed: initiation of twinkling artifact, contouring fistula cavity, panorama scanning, change in the type and frequency of the probe, ultrasonic contrast enhanced fistulography, creating "gel pad" that improved diagnostic results in 69.7±4.3% of patients. Study was carried out on echo-semiotics of ligature fistulas at different stages of formation and ultrasonic characteristics of their main components. Typical echo signs of ligatures were documented, the main of which was the presence of two hyperechoic structures corresponding to knot and coiled loops with parallel acoustic shadows. A classification is proposed based on data from ultrasound examination, including stem (61.8±4.6%), coiled (12.7±3.2%), tree-like (16.4±3.5%) and multicentric (9.1±2.7%) ligature fistulas. The possibilities of using ultrasonography in the differential diagnosis of ligature fistulas with external fistulas of other etiologies, and periligature abscesses with postoperative fluid collections were studied. A minimally invasive treatment method of ligature fistulas with echo-controlled extraction of ligature fistula or through skin incision was developed, the effectiveness of which (97.3±1.6%) was significantly higher, and the number and quality of complications (3.6±1.8%) was significantly lower than the traditional method of treatment. High-energy laser exposure under ultrasound guidance is proposed as a method of arresting hemorrhage through the fistula course.