DOI: https://doi.org/10.15587/2313-8416.2015.50323

Clinical and experimental substantiation of the method the biliary debit manometry

Николай Николаевич Велигоцкий, Николай Николаевич Скалий, Александр Викторович Горбулич, Сергей Эдуардович Арутюнов, Станислав Артурович Павличенко, Александр Александрович Лермонтов

Abstract


Introduction. In spite of the permanent improvement of the diagnostic methods of causes of biliary obstruction it has not 100 % sensitivity and specificity and received data can be erroneous and difficult for clinical interpretation.

Substantiation. To assess at the modern scientific and technical level the functional state of patency of terminal section of choledoch using modified method of debit manometry that consists in registration of the volume of liquid injected into bile-excreting and the pressure in it.

Materials and methods of research. At elaboration of methods at the first stage it was carried out numerical modeling on the base of physical model of bile-excreting system with assessment of the levels of pressure in bile-excreting ducts at liquid injection, assessment of form of the curve of pressure changes and factors that influence on form and parameters of curve. At the second stage it was carried out an experimental assessment of correspondence of these models to the real data received in department of morbid anatomy. And at the last clinical stage it was carried out diagnostics of disorders of patency of bile-excreting system with following assessment of diagnostic and practical value of this method.

Results. The data received in experiment and modeling allowed to interpret the results of debit manometry received at examination of patients on the next algorithm: at the first stage it was assessed the type of curve: bell-shaped – disorder of outflow is absent but at the fast evacuation the disorders of consistency of sphincteral apparatus cannot be excluded, tooth-shaped – indicates the disorder of outflow of bile what can be caused by both organic and functional reasons, horizontal type – indicates the strict obstruction usually of organic character. At the second one it were assessed the quantitative indicators, the high level of pressure at the bolus introduction testified to the bile-excreting ways (BEW) obstruction, the low one – to an inconsistency of sphincteral apparatus.

Conclusions. The numerical experimental data allowed establish regularities of bile-excreting system functioning from the positions of hydrodynamics. Verification of these data in conditions of controlled experiment on the real bile-excreting ducts allowed confirm these conclusions and specify the features of hemodynamics in conditions of dissected sphincteral apparatus


Keywords


biliary debit manometry; experimental substantiation; modeling

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Copyright (c) 2015 Александр Викторович Горбулич, Николай Николаевич Велигоцкий, Николай Николаевич Скалий, Сергей Эдуардович Арутюнов, Станислав Артурович Павличенко, Александр Александрович Лермонтов

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