surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2025-15-4-376-383surgonco-1150Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASESЦифровая холангиоскопия при внутрипеченочном холелитиазе после трансплантации печени: клинический случайDigital Cholangioscopy in Intrahepatic Cholelithiasis after Liver Transplantation: Clinical casehttps://orcid.org/0000-0001-8673-0554НартайлаковМ. А.NartailakovM. A.

Нартайлаков Мажит Ахметович — д.м.н., профессор, кафедра общей хирургии, трансплантологии и лучевой диагностики

Республика Башкортостан, Уфа 

Mazhit A. Nartailakov — Dr. Sci. (Med.), Prof., Department of General Surgery, Transplantology and X-ray Diagnostics

Ufa 

https://orcid.org/0000-0002-8338-2766НагаевФ. Р.NagaevF. R.

Нагаев Фарит Робертович — хирургическое отделение, кафедра общей хирургии, трансплантологии и лучевой диагностики

Республика Башкортостан, Уфа 

Farit R. Nagaev — Surgery Unit, Department of General Surgery, Transplantology and X-ray Diagnostics

Ufa 

https://orcid.org/0000-0002-4160-2820БакеевМ. Р.BakeevM. R.

Бакеев Марат Радикович — ординатор, кафедра хирургических болезней лечебного факультета, хирургическое отделение

Республика Башкортостан, Уфа

Marat R. Bakeev — Resident, Department of Surgical Diseases, Faculty of Medicine, Surgery Unit

Ufa 

m.r.bakeev@bk.ruhttps://orcid.org/0000-0002-4292-1831МинигалинД. М.MinigalinD. M.

Минигалин Даниил Масхутович — к.м.н., кафедра хирургических болезней лечебного факультета, хирургическое отделение

Республика Башкортостан, Уфа

Daniil M. Minigalin — Cand. Sci. (Med.), Department of Surgical Diseases, Faculty of Medicine, Surgery Unit

Ufa 

https://orcid.org/0000-0002-0148-4559СафаргалинаА. Г.SafargalinaA. G.

Сафаргалина Айгуль Гирфановна — кафедра хирургических болезней лечебного факультета, хирургическое отделение

Республика Башкортостан, Уфа

Aygul G. Safargalina — Department of Surgical Diseases, Faculty of Medicine, Surgery Unit

Ufa 

Башкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian FederationБашкирский государственный медицинский университет ; Клиника Башкирского государственного медицинского университетаРоссияBashkir State Medical University ; Clinic of Bashkir State Medical UniversityRussian Federation202524122025154376383Copyright © Нартайлаков М.А., Нагаев Ф.Р., Бакеев М.Р., Минигалин Д.М., Сафаргалина А.Г., 20252025Нартайлаков М.А., Нагаев Ф.Р., Бакеев М.Р., Минигалин Д.М., Сафаргалина А.Г.Nartailakov M.A., Nagaev F.R., Bakeev M.R., Minigalin D.M., Safargalina A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/1150

Введение. Трансплантация печени является окончательным методом лечения для пациентов с поражениями печени терминальных стадий. У реципиентов трансплантированной печени способны возникать стриктуры билиодигестивного анастомоза, холелитиаз различной локализации. У ряда пациентов со сложными формами холелитиаза и билиарных стриктур применение рутинной эндоскопической процедуры может оказаться неэффективным. В подобных ситуациях перспективен метод прямой цифровой холангиоскопии SpyGlass DS™. Материалы и методы. Клинический случай: у пациента 66 лет в позднем послеоперационном периоде после ортотопической родственной трансплантации печени диагностированы стриктура реконструктивного гепатикоеюноанастомоза на петле по Ру и внутрипеченочный холелитиаз. Произведено гибридное вмешательство — баллонная дилатация стриктуры и внутрипеченочная литотрипсия, литоэкстракция с использованием холангиоскопии SpyGlass DS™, а также чрескожное чреспеченочное дренирование желчевыводящих путей под контролем рентгенографической системы. Результаты и обсуждение. Выполнение прямой холангиоскопии позволило безопасно устранить гепатолитиаз и стриктуру гепатикоеюноанастомоза у пациента после трансплантации печени. Выполнение наружного дренирования с возможностью отсроченной холангиографии позволило контролировать функцию желчевыделения и поэтапно производить замену дренажей. Заключение. Прямая цифровая холангиоскопия выступает важным инструментом диагностики и лечения билиарных осложнений у реципиентов трансплантированной печени.

Introduction. Liver transplantation represents the definitive treatment for patients with end-stage liver disease. In liver transplant recipients, strictures of the biliary-digestive anastomosis and cholelithiasis of various localizations may occur. However, routine endoscopic procedures may be ineffective in some patients with complex forms of cholelithiasis and biliary strictures. In such situations, the SpyGlass DS™ direct digital cholangioscopy method is promising. Materials and methods. Clinical case: a 66-year-old patient in the late postoperative period after orthotopic related liver transplantation was diagnosed with a stricture of the reconstructive hepaticojejunostomy on the Roux-en-Y loop and intrahepatic cholelithiasis. The performed hybrid intervention includes: balloon dilation of the stricture and intrahepatic lithotripsy, lithoextraction using SpyGlass DS™ cholangioscopy, as well as percutaneous transhepatic drainage of the biliary tract under radiographic control. Results and discussion. Direct cholangioscopy ensured the safe elimination of hepatolithiasis and hepaticojejunostomy stricture in a patient after liver transplantation. External drainage with the possibility of delayed cholangiography was used to monitor the function of bile secretion with gradual replacement of drains. Conclusion. Direct digital cholangioscopy represents an important tool for the diagnosis and treatment of biliary complications in liver transplant recipients.

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The authors declare that there are no conflicts of interest present.