DIAGNOSIS OF HEMODYNAMIC CHANGES OF THE LIVER IN CONDITIONS OF BILIARY HYPERTENSION WITH PERFUSION COMPUTED TOMOGRAPHY
Rubrics: SURGERY & NEUROSURGERY
Authors:
1.
Irkutsk Municipal Clinical Hospital N 1
(Radiological Unit, Radiologist)
Irkutsk, Irkutsk region, Russian Federation
Irkutsk, Irkutsk region, Russian Federation
2.
Irkutsk, Irkutsk region, Russian Federation
Type:
Article
Pages:
from 137
to 141
Status:
Published
Received:
14.11.2017
Accepted:
30.11.2017
Published:
30.11.2017
Subject area:
UDK 61 Медицина. Охрана здоровья
Language:
Russian
Keywords:
mehanicheskaya zheltuha, perfuzionnaya komp'yuternaya tomografiya, biliarnaya dekompressiya
Abstract (English):
S razvitiem tehnologiy vizualizacii mul'tisrezovoy komp'yuternoy tomografii i poyavleniem kommercheskogo programmnogo obespecheniya v literature vse chasche stali poyavlyat'sya raboty, ocenivayuschie vozmozhnosti perfuzionnoy komp'yuternoy tomografii pri razlichnyh zabolevaniyah pecheni. U pacientov s obstrukciey zhelchnyh protokov suschestvuet potrebnost' dopolnitel'nyh kriteriev funkcional'nogo sostoyaniya pecheni. V nastoyaschiy moment ostaetsya nereshennym vopros haraktera izmeneniya tkanevoy gemodinamiki pri bloke biliarnogo trakta. V rabote predstavleny dannye rezul'tatov perfuzionnoy komp'yuternoy tomografii 47 pacientov s sindromom mehanicheskoy zheltuhi. Pacienty byli razdeleny na dve gruppy: pervaya – pacienty s dlitel'nost'yu zheltuhi do 7 dney i urovnem obschego bilirubina do 150,0 mkmol'/l (n = 29), vtoraya – pacienty s dlitel'nost'yu zheltuhi bol'she 7 dney i urovnem obschego bilirubina bol'she 150,0 mkmol'/l (n = 18). V gruppe pacientov s legkoy stepen'yu statisticheski znachimyh izmeneniy arterial'noy i portal'noy gemodinamiki ne proishodit. Vo vtoroy gruppe proishodit snizhenie pokazateley portal'noy perfuzii do 50,0 %, obschey perfuzii pecheni – do 25,5 %. Vo vtoroy gruppe u chasti pacientov posle dekompressiii biliarnoy sistemy otmecheno razvitie neblagopriyatnyh ishodov. Vtoraya gruppa byla razdelena na dve podgruppy – s blagopriyatnymi i neblagopriyatnymi ishodami. Neblagopriyatnym ishodom schitali razvitie posleoperacionnyh oslozhneniy v vide priznakov endotoksemii, gnoyno-septicheskih oslozhneniy, prisoedineniya poliorgannoy nedostatochnosti. U pacientov vtoroy gruppy s razvivshimisya neblagopriyatnymi ishodami proishodit bolee vyrazhennoe snizhenie portal'noy perfuzii do 68,0 % i obschey perfuzii pecheni – do 40,0 %. Snizhenie dannyh pokazateley mozhet yavlyat'sya cennym prognosticheskim kriteriem razvitiya posleoperacionnyh oslozhneniy.
S razvitiem tehnologiy vizualizacii mul'tisrezovoy komp'yuternoy tomografii i poyavleniem kommercheskogo programmnogo obespecheniya v literature vse chasche stali poyavlyat'sya raboty, ocenivayuschie vozmozhnosti perfuzionnoy komp'yuternoy tomografii pri razlichnyh zabolevaniyah pecheni. U pacientov s obstrukciey zhelchnyh protokov suschestvuet potrebnost' dopolnitel'nyh kriteriev funkcional'nogo sostoyaniya pecheni. V nastoyaschiy moment ostaetsya nereshennym vopros haraktera izmeneniya tkanevoy gemodinamiki pri bloke biliarnogo trakta. V rabote predstavleny dannye rezul'tatov perfuzionnoy komp'yuternoy tomografii 47 pacientov s sindromom mehanicheskoy zheltuhi. Pacienty byli razdeleny na dve gruppy: pervaya – pacienty s dlitel'nost'yu zheltuhi do 7 dney i urovnem obschego bilirubina do 150,0 mkmol'/l (n = 29), vtoraya – pacienty s dlitel'nost'yu zheltuhi bol'she 7 dney i urovnem obschego bilirubina bol'she 150,0 mkmol'/l (n = 18). V gruppe pacientov s legkoy stepen'yu statisticheski znachimyh izmeneniy arterial'noy i portal'noy gemodinamiki ne proishodit. Vo vtoroy gruppe proishodit snizhenie pokazateley portal'noy perfuzii do 50,0 %, obschey perfuzii pecheni – do 25,5 %. Vo vtoroy gruppe u chasti pacientov posle dekompressiii biliarnoy sistemy otmecheno razvitie neblagopriyatnyh ishodov. Vtoraya gruppa byla razdelena na dve podgruppy – s blagopriyatnymi i neblagopriyatnymi ishodami. Neblagopriyatnym ishodom schitali razvitie posleoperacionnyh oslozhneniy v vide priznakov endotoksemii, gnoyno-septicheskih oslozhneniy, prisoedineniya poliorgannoy nedostatochnosti. U pacientov vtoroy gruppy s razvivshimisya neblagopriyatnymi ishodami proishodit bolee vyrazhennoe snizhenie portal'noy perfuzii do 68,0 % i obschey perfuzii pecheni – do 40,0 %. Snizhenie dannyh pokazateley mozhet yavlyat'sya cennym prognosticheskim kriteriem razvitiya posleoperacionnyh oslozhneniy.
Keywords:
mehanicheskaya zheltuha, perfuzionnaya komp'yuternaya tomografiya, biliarnaya dekompressiya
mehanicheskaya zheltuha, perfuzionnaya komp'yuternaya tomografiya, biliarnaya dekompressiya
1. Diagnostika gemodinamicheskih izmeneniy pecheni
