EVOLUTION PROBLEMS OF DIFF ERENTIAL DIAGNOSIS OF JAUNDICE IN THE WESTERN URALS

The purpose of the study. To present the history of differential diagnosis of jaundice in the Perm region. Materials and methods. The study used narrative, historical-genetic, comparative and structural methods. Results. The number of patients with diseases of the liver and biliary tract, manifested by obstructive jaundice syndrome is steadily increasing. Indirect methods of contrast enhancement turned out to be untenable in the presence of hypertension in the biliary tract. Direct opacification of the biliary tract originally performed by intraoperative cholangiography via the cystic duct stump. The method of percutaneous transhepatic cholangiography (transparietal cholangiography), promoted in the 60-ies of the several hospitals of the Soviet Union, is not widely spread due to the lack of imaging punchthrough ducts. Head of Department of hospital surgery, Perm medical Institute Professor S. Y. Minkin on 27m all-Union Congress of surgeons in 1960 first reported cholestatic jaundice without mechanical barriers to the outflow of bile. The use of electron microscopy made it possible to develop universally accepted diagram of the structure of the biliary tract. On the basis of the pathogenetic classification of Professor E. N. Ter-Grigorova algorithm of differential diagnosis, which can be used for computer calculation of the characteristics manually, or simply in the form of visual diagrams (L. F. Pulatova, 1977). In order to diagnose the functional state of the liver was applied isotope hepatography. Significantly advanced diagnosis using endoscopic techniques, laparoscopic cholecystocholangiography, endoscopic retrograde cholangiopancreatography. Distal levels of obstruction of the biliary tract were identified using the relaxation of duodenography, ultrasound and endomicroscope research. Computer and magnetic resonance imaging, especially magnetic resonance-cholangiography has virtually solved the problem. Invasive methods are mainly used for diabeticheskoi techniques, the research also serves as the first stage of surgical treatment for relief of biliary tree and the elimination of biliary hypertension. Advances in diagnosis have led to the progress in surgical treatment. If in the middle of the twentieth century, the most frequent operation was palliative cholecystojejunostomy, and high tumor - tunnelization of the tumor, it is now in daily clinical practice included pancreatoduodenectomy, liver resection for tumors of the gate as a portal, and navalnyj. Wide application of mini-invasive methods (endoscopic cholangiopancreatography, percutaneous transhepatic cholangiography, mini-accesses, puncture under ultrasound control) allows to reduce operational risk and prevent the development or progression of liver failure, which greatly improves treatment results Conclusion. Evolution of morphological and clinical methods for differential diagnosis of jaundice has enabled the optimization of surgical tactics, which currently contains a whole spectrum of interventions, from minimally invasive diabeticheskoi methods to extensive radical surgery.

Obstructive jaundice, pathological physiology, intraoperative cholangiography, hepatocyte, hyperbilirubinemia, percutaneous transhepatic cholangiography

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