Manodebitometry in intraoperative diagnosis of extrahepatic cholestasis in complicated cholelithiasis
Keywords:manodebitometry, extrahepatic cholestasis, complicated cholelithiasis
Background. The purpose was to evaluate the effectiveness of the combined method of manodebitometry in intraoperative diagnosis of the causes of various types of extrahepatic cholestasis (ЕНС) in complicated cholelithiasis. Materials and methods. Manodebitometry was performed in 181 patients who were operated at the Department of Surgery of the Digestive Organs of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine for the period from 2013 to 2020 using developed software and hardware complex. All patients underwent ultrasound examination before surgery, and if choledochocalculosis was suspected — endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. The motor-evacuatory function of the gallbladder was also assessed. Results. Depending on the presence of biochemical markers of jaundice and hepatocyte damage, as well as the presence of cholestasis predictors in the past medical history, patients were divided into 5 groups of extrahepatic cholestasis. The use of a combined method of manodebitometry in the intraoperative diagnosis of the main causes of various types of EHC in complicated cholelithiasis allowed us to diagnose organic disorders as the cause of EHC in 34 (18.78 %) patients, and in 38 (20.99 %) patients — functional disorders of the sphincter of Oddi. Receiver operating characteristic (ROC) analysis of application of the combined technique of manodebitometry as diagnostic screening of the functional and organic cause of EHC in complicated cholelithiasis made it possible to establish high quality of diagnostic model with the use of determined coefficient as an optimum threshold of classification with accuracy of 88.9 %, sensitivity of 93.6 %, specificity of 80 %, as area under the ROC-curve was 0.9311 (95% confidence interval 0.918–0.929; p < 0.0001). Conclusions. The manodebitometric examination of choledochus during surgery with a pharmacological test for relaxation allows increasing by 34.8 % the detection of the causes of EHC in complicated cholelithiasis, identifying its dysfunction and can be recommended for practical use for recognizing the type of EHC, its main causes and intraoperative indications for their correction during operation.
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