УЛЬТРАЗВУКОВЫЕ ПРИЗНАКИ ЖЕЛЧНОГО ПУЗЫРЯ У БОЛЬНЫХ ОСТРЫМ ХОЛЕЦИСТИТОМ И ОБСТРУКЦИЕЙ ЖЕЛЧЕВЫВОДЯЩИХ ПУТЕЙ В СЛУЧАЯХ ВИЗУАЛИЗАЦИИ В ЕГО СТЕНКЕ ВЕНОЗНО-АРТЕРИАЛЬНОГО ТИПА КРОВОТОКА

B-mode ultrasound features of the gallbladder changes and Doppler-parameters of increased blood flow in the gallbladder wall as a type of arterial or venous hyperemia are considered the generally recognized signs of acute cholecystitis. However, we did not find information about the influence of intravesical pressure on the cystic artery blood flow, as any date of presence or absence of connection between B-mode gallbladder signs and the degree of venous blood flow change in the gallbladder wall in patients with acute calculous cholecystitis and bile duct obstruction, accompanied by intravesical hypertension. The aim of the study was to identify B-mode ultrasound signs of the gallbladder (GB), in which veins are registered in its wall along with the arteries. This type of blood flow is classified as a venous-arterial type. The venous-arterial blood flow was identified by color duplex scanning in 34 observed people (23,6%) out of 144 patients with acute calculous cholecystitis. While in case of non-inflammatory bile duct obstruction, veins in the GB wall were visualized in 1,9 times more often and were detected in 20 out of 44 (45,5%) patients. Comparing each group with patients who had only an arterial type of blood flow, we obtained the following results: the largest values of the length, area and volume of the gallbladder were identified in patients with recording veins in GB wall, which differed them with a high degree of reliability (p<0,05) from patients with only arterial type of blood flow. Intraoperative intravesical pressure measurement was conducted to all patients. The level of pressure was also significantly higher in patients with venous-arterial blood flow in GB and shows 26,1±2,6 mm water column to compare with 18,0±3,2 mm water column in patients with acute calculous cholecystitis when only arterial blood flow was registered in the GB wall (increase 31,1%); In case of bile duct obstruction the values were 29,0±1,8 mm water column and 25,7±1,6 mm water column respectively. The obtained data shows significance of the intravesical pressure level to the detection of venous blood flow in GB wall by Color Duplex method. The probability of recording venous blood flow in the GB wall in patients with acute calculous cholecystitis and with bile duct obstruction grows with the increase in the length, area and volume of GB to the maximum values.