Postcholecystectomy syndrome is a complicated symptom complex of functional genesis observed in a number of patients after undergoing cholecystectomy. To diagnose the postcholecystectomy syndrome, patients are examined in several stages, and surgical intervention is used to treat complications of postcholecystectomy syndrome. That is why it is very important to diagnose abnormalities in the biliary system functioning in a timely manner in order to avoid an increase in the number of surgical corrections for the complicated course of the postcholecystectomy period. Initially, abnormalities developing in the biliary system after cholecystectomy may not be amenable to diagnosis according to the applicable algorithm, and all indicators, including laboratory and instrumental ones, are not sensitive to incipient changes. Liver elastography is one of modern methods of examining the hepatic parenchyma stiffness used in patients with postcholecystectomy syndrome. This method, unlike ultrasound, enables to measure the degree of fibrosis and, at the early stages of liver structure changes, indicate emerging problems with the hepatobiliary system. The aim of the study was to evaluate the clinical and diagnostic opportunities of the author's liver elastography technique in the study of patients with postcholecystectomy syndrome. Materials and methods. All patients with postcholecystectomy syndrome were examined by the method developed by us (group 1) and by the method adopted in the medical institution earlier (group 2). Group 1 consisted of patients with a history of cholecystectomy (n = 27, 51.9%), examined by protocols according to clinical recommendations, which include magnetic resonance cholangiopancreatography, biochemical blood analysis (alanine aminotransferase, aspartate aminotransferase, bilirubin, alkaline phosphatase), multiparametric ultrasound (B-mode, shear wave elastography in all areas of interest). Despite a sufficient number of advantages, this diagnostic algorithm has a number of disadvantages: significant time required for conducting the study, lack of diagnostic sensitivity at the initial stages of changes in the biliary system (clinical manifestations are not pronounced or expressed insignificantly, laboratory data are within normal values). Group 2 consisted of patients with a history of cholecystectomy (n = 25, 48.1%). Statistical processing of the data obtained was carried out using Statistica 7, Statistical Package for the Social Sciences – 10, ROC analysis (receiver operating characteristics), receiver operating characteristic analysis (MedCalc) comparative test with 95% confidence interval. Results. The patients’ examination was carried out according to our proposed methodology and included two main stages and one additional one. The first stage was to perform compression elastography to determine the areas of greatest stiffness that are localized in postcholecystectomy syndrome in segments VI or VII. The second (main) step was to perform two-dimensional shear wave elastography. Areas of interest: VI–VIII segments, IV–V, II–III and a fragment of segment I, performing at least three measurements. When analyzing the data obtained, all groups of factors (patient-dependent, hardware-dependent, operator-dependent) affecting the final result were taken into account. The third (additional) stage was using the algorithm that we developed: performing compression elastography of the liver in patients with postcholecystectomy syndrome, evaluating the results, then performing two–dimensional shear wave elastography, where the indicators of two-dimensional shear wave elastography of the liver were accurately assessed in the area of the greatest stiffness localization by the data of compression elastography, respectively VI-VIII segments. Then, the time spent on the same study using routine and the author's methods was analyzed; their awareness (the number of false positive and false negative results) and reproducibility were evaluated. At the examination stage, doctors were given the opportunity to work using two diagnostic algorithms: in accordance with the clinical recommendations and according to the author's methodology proposed by us. The first algorithm did not cause difficulties with reproducibility (the examination time varied and averaged about 30 minutes). The study time for the second algorithm exceeded the time of the first one (33 minutes on average per study). However, the total time spent on the study was reduced due compliance with the study stages according to our proposed algorithm (the time spent according to the author's research methodology was 19 minutes). According to the results of the study, the number of false positive and false negative results was estimated for the technique corresponding to clinical recommendations (25% and 40%, respectively), and the author's technique (15% and 25%, respectively). Therefore, the algorithm that we proposed provides significant diagnostic information when examining groups of patients with postcholecystectomy syndrome. Conclusions. The proposed technique of combining compression and two-dimensional shear wave elastography in patients with postcholecystectomy syndrome increases its reproducibility and reduces the number of false positive and false negative results, which contributes to the correct choice of treatment tactics.
