26 KB72 KB27 KB200520132006Mlinarič, Vladimirletnik:11številka:257 stranistr. 49-55ISSN:1318-8941COBISSID:21317337URN:URN:NBN:SI:doc-16E9W3BFslSlovensko zdravniško društvoEndoskopska revijaBiliary Tract SurgeryCholangiopancreatography, Endoscopic RetrogradeCholangitisCholelithiasisCholestasisCommon Bile Duct CalculidiagnostikaendoscopyEndoscopy, Digestive SystemendoskopijaEndoskopija prebavilEndosonografijaEndosonographyHolangiopankreatografija endoskopska, retrogradnaHolangitisHoledohus, kamniHolestazaJetra, presaditevLiver TransplantationmetodePancreatitisPankreatitisPapila Vateriprebavilatherapytrebušna slinavkaVater'S AmpullazdravljenježolčevodŽolčni kamnižolčnikDiagnostični in terapevtski posegi na biliarnem traktu| Diagnostic and therapeutic procedures in biliary tract diseases|Several noninvasive diagnostic techniques, including contrast-enhanced two-phase spiral CT, 3D ultrasound, and, the most important MR cholangiopancreatography, have been widely adopted in the recent years. Despite their high sensitivity and specificity rates, they have not yet replaced endoscopic retrograde cholangiography (ERCP), which remains the gold standard procedure in the diagnosis of biliary tract pathology. The algorithm for differential diagnosis involves the use of oesophagogastroduodenoscopy (EDGS) and endoscopic ultrasound in specific cases. EDGS is used to assess patency of the upper digestive tract, and to detect primary pathological changes and consequences of the diseases affecting the gallbladder, bile ductsor pancreas (malignant overgrowth, fistula formation, ulceration). Endoscopic ultrasound provides the most accurate information about ampullary and periampullary lesions, and changes in the common bile duct, gallbladder, and the adjacent great vessels and lymph nodes. ERCP done with other endoscopic surgical procedures, such as endoscopic papillotomy (ETP), electroresection of the ampulla of Vater, lithotripsy, retrieval of calculi and foreign bodies, dilatation of strictures and endoscopic bile drainage (stenting and nasobiliary tube placement), remains an irreplacable tool in thetreatment of biliary tract diseases. When choosing the most appropriate approach to diagnosis and treatment of gallbladder and bile duct diseases one should consider the scope and limitations of individual techniques and their role in the complementary treatment of these diseases (endoscopy-surgery, interventional radiology and conventional and laparoscopic surgery)V zadnjih letih uveljavljene neinvazivne diagnostične metode, kot so dvofazna spiralna računalniška tomografija z intravenskim kontrastom (spiralni CT), tridimenzionalni ultrazvok (3D-UZ), predvsem pa magnetnoresonančna holangiopankreatografija (MRCP), se po občutljivosti in specifičnosti sicer približujejo endoskopski retrogradni holangiografiji (ERCP), a je (še) ne morejo zamenjati kot zlati diagnostični standard pri boleznih biliarnega trakta. V algoritmu diferencialnodiagnostičnih postopkov imata v določenih primerih svoj pomen tudi ezofagogastroduodenoskopija (EGDS) in endoskopski ultrazvok (EUZ). S prvo ugotavljamo prehodnost zgornje prebavne cevi, morebitne primarne bolezenske spremembe ali sekundarne posledice bolezni žolčnika, žolčevodov in trebušne slinavke (maligno preraščanje, fistuliranje, ulkusna bolezen in drugo). Z EUZ doslej najbolj natančno med drugim ocenjujemomorebitne bolezenske spremembe ampularne in periampularne regije, skupnega žolčevoda, žolčnika in okolice (predvsem veliko ožilje in bezgavke). ERCP ostaja z operacijskimi endoskopskimi posegi, kot so endoskopska papilotomija (EPT), elektroresekcija Vaterijeve papile (ampulotomija), litotripsija, ekstrakcija kamnov in tujkov, dilatacija striktur in endoskopskabiliarna drenaža (stentiranje in nazobiliarno sondiranje), nepogrešljiva pri zdravljenju bolezni biliarnega trakta. Pri izbiranju možnosti za ugotavljanje in zdravljenje bolezni žolčnika in žolčevodov je zatopotrebno poznati domet oziroma omejenost posamezne metode in njeno mesto vkomplementarni endoskopsko-kirurški, rentgensko-interventni in kirurški (klasičnem in laparoskopskem) obravnavi teh bolezniTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo, Združenje za endoskopsko kirurgijo