The low diagnostic efficiency of USI in verification of MS was noted in group of patients with MS I type,
with the highest percentage of not established diagnosis (57,1% in main and 78,3% in control groups).
Nevertheless, in main group almost in 2 times it was increased the percentage of typing diagnosis. The highest
percentage of correct made diagnosis was noted in patients with MS II-IV type (23,1% against 15,2%
respectively). In main group of patients with MS II-IV type it was decreased significantly the percentage of
unverified diagnosis (30,8% against 54,3% respectively).
Verification of diagnosis on the base of totality of main USS signs of MS allows to increase diagnostic
efficacy of this method till 18,9% in all types, and for 2-4 type particularly till 23,1%. The use of MRI and MSCT in
verification of MS allows increasing the efficiency of diagnosis in 2 times in comparison with USS. But, for
patients with MS 1 type this indication remains relatively low and composes only 33,3%. The highest efficiency
of this diagnosis method is revealed in patients with MS 2-4 type with exact made diagnosis in 75,0% cases. The
efficacy of ERPCHG in MS 1 type composes 66,7%, and in MS 2-4 type it increases till 75,8%, which associated
with increasing of efficiency of beam diagnostic methods, not with the improvement of technical components of
this method. It was noted significant increasing of topical diagnosis level of MS 1 type in main group (till 42,9%),
and for patients with MS 2-4 type this indication in main group increased till 19,2% in comparison with control
group. At the same time, stage using of all complex of diagnostic monitoring may increase the efficacy of
making of correct diagnosis till 97-99% in patients with MS 2-4 type.
The use of stage surgical tactics, when on the first stage it was performed one of the variants of small-
invasive biliary tract decompression, was characterized with the increasing of amount of planned surgical
interventions (90,6% against 69,6%), the highest percentage of applying of laparoscopic technologies (16,98%
against 4,35%) in minimal quantity of conversion (3,8% against 15,94%) and as a result: uncomplicated post-
operative period was noted in 83,0% of patients of main group, while in patients of control group this indication
composed only 56,5%. Such difference was noted both in indications of lethality (1,9% in main group against 7,2%
in control) and specific complications (15,1% in main group against 39,1% in control).
Renouncement from emergency surgery in favor of actively expectant tactics in MS allows to increase the
rate of good results after operation till 26,5%, to reduce the quantity of specific and non-specific post-operative
complications till 24,0% and 24,2% respectively, and lethality till 5,3%.
The main tasks of therapeutic and diagnostic tactics in MS in the condition of given qualified and
specialized medical care are follows:
Collection of anamnestic data and determination of risk factors of MS developing;
Use of high technologic beam diagnosis with establishment the character of complication;
Assessment of efficiency of combined use of all diagnostic complex in MS verification;
Assessment of severity stage of clinical course of syndrome, determination of complicated course of
underlying disease and concomitant pathology;
In patients with MJ, the first stage of therapeutic tactics is one of the ways of small-invasive
endoscopic or endovascular decompression of biliary tract;
In preliminarily established MS 1-2 type the preference should be given to laparoscopic intervention,
and in the case of revealing of MS 3-4 type the priority remains for the choice of open operation
(CHEC+draining of choledocha by Ker).
This work was supported by Republican Specialized Center of Surgery named after acad.V.Vakhidov.
All authors contributed equally to this work.
The authors declare that they have no comp eting interests.
To cite this paper: Nazirov F.G., Akbarov M.M., Nishanov М.Sh. (2018). Diagnosis and Surgical Treatment of Patients with Mirizzi Syndrome. J. Life Sci. Biomed.