Background. Being one of the most common pathologies of bile ducts, choledocholithiasis (CHL) is complicated by mechanical jaundice (MJ) in 21.4–46.3% of cases. Choice of optimal treatment mode and operation method is still a difficult problem.
Purpose of study is estimation of the results of mini-invasive methods using in diagnostics and treatment of CHL.
Methods. During 2007–2011 years 273 patients were treated with the diagnosis CHL aged from 24 to 92 y.o., 254 (93.0%) of them had symptoms of MJ. Abdominal ultrasound (US) was used for screening CHL, computer tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic fistulocholangiography, intraoperative cholangiography or cholangioscopy, intraoperative or transduodenal fibrocholedochoscopy (FCHS) were used when indicated. Surgical treatment included mini-invasive interventions (endoscopic papillosphincterotomy (EPST), percutaneous transhepatic bile duct catchment, laparoscopic cholecystectomy, choledocholithoextraction (CHLE) with following external or internal bile duct catchment), and traditional operations. Surgical treatment of patients with MJ was fulfilled in one or two stages.
Results. High rates of diagnostic test criteria were found in FCHS (sensitivity — 97.3%, specificity — 100.0%, accuracy — 98%, effectiveness — 97.7%), US (95.8%, 78.8%, 90.5%, 77.1% respectively), CT (91.1%, 73.4%, 84%, 77.2% respectively). It is estimated that if the concrement has diameter of 2–7 mm, the use of EPST leads to its migration from biliary ducts to the intestine in 83.7% of patients; 8–10 mm — removal is possible in 86.5% of cases only by CHLE; 11–15 mm — mechanical lithotrypsy with stone extraction using Dormia basket is possible only in 30% cases.
Conclusions. CHL diagnostics should be performed using complex of medical tests (US, CT, ERCP and FCHS). Using of mini-invasive methods such as EPST, transpapillar mechanical lithotrypsy, endovideosurgery allow to treat patients with CHL radically.