Использование аппаратно-инструментальных методов в диагностике синдрома Мириззи

Abstract

The aim of the study was a comparative description of the instrumental methods effectiveness in the preoperative diagnostics of Mirizzi syndrome (MS). Materials and methods. An analysis32 of the examination and treatment results of the 410 patients with cholelithiasis and suspected according to clinical data Mirizzi syndrome, was carried out for the period of 1997-2019. In 202 patients, various forms of Mirizzi syndrome were confirmed intraoperatively. Mirizzi type I syndrome was diagnosed in 80 (39.6%) patients, Mirizzi type II-V syndrome - in 128 (60.4%). There were 66 men (31.7%) and 136 women (68.3%). The age of patients ranged from 37 to 80 years (an average of 66.4 years). All patients were examined using ultrasonography (USG) of the abdominal cavity, multispiral CT with intravenous contrast enhancement; endoscopic retrograde cholangiopancreatography (ERCP); magnetic resonance imaging (MRI) of the abdominal cavity with cholangiopancreatography (MRCP). After examined all patients underwent surgery. Comparing intraoperative data and data from instrumental studies, we determined the diagnostic specificity, sensitivity, effectiveness of the method, as well as the value of false positive and false negative results and predictive value of positive and negative diagnostic results. Results. After conducting a comprehensive examination using instrumental diagnostic methods, it was found that the effectiveness of USG in patients with type I MS is 55%, sensitivity - 57.5%, specificity - 52.2%. For ERCP, the efficiency was 75.6%, sensitivity - 76%, specificity - 75%. The highest efficiency in the diagnosis of MS type I was demonstrated by magnetic resonance cholangiopancreatography - 84% with sensitivity and specificity of 83% and 85%. In patients with MS ІІ (II-V) type, the effectiveness of USG was 68.8%, sensitivity - 67%, and specificity - 70%. The efficiency of ERCP was 81% with a sensitivity of 78.6% and a specificity of 83.6%. For CT, the efficiency in the preoperative diagnosis of type II MS was 61%, sensitivity - 60%, and specificity - 63%. The highest efficiency in the diagnosis of MS type II was demonstrated by magnetic resonance cholangiopancreatography - 90%, with sensitivity and specificity of 93% and 87.5% respectively.