Postkholetsistektomichesky syndrome – the specific simptomokompleks caused by the postponed holetsistektomiya and the changes of functioning of zhelchevydelitelny system connected with it. Recidivous painful attacks, dispepsichesky frustration, diarrhea and , hypovitaminosis, decrease in body weight belong to manifestations of a postkholetsistektomichesky syndrome. For identification of the reasons of a syndrome ultrasonography and MSKT of an abdominal cavity, a fibrogastroduodenoskopiya, RHPG is carried out. Treatment of a postkholetsistektomichesky syndrome can be conservative (the sparing diet, reception of spazmolitik and enzymes) and surgical (drainage of bilious channels, an endoscopic sfinkteroplastika, etc.).
The Postkholetsistektomichesky syndrome is a complex of clinical symptoms developing owing to expeditious removal of a gall bladder. Patients at whom the holetsistektomiya with errors is carried out do not enter into group of patients with a postkholetsistektomichesky syndrome, there were stones in bilious channels, the postoperative pancreatitis which is followed by a sdavleniye of the general bilious channel developed, holangit.
The Postkholetsistektomichesky syndrome occurs on average at 10-15% of patients (at the same time in different groups this indicator reaches 30%). At men it develops almost twice less than at women. The Postkholetsistektomichesky syndrome can develop right after carrying out expeditious removal of a gall bladder, and can be shown later a long time (several months, years).
Reasons of development of a postkholetsistektomichesky syndrome
The major pathogenetic factor of development of a postkholetsistektomichesky syndrome is violation in biliarny system – pathological circulation of bile. After removal of the gall bladder which is the tank for the developed liver of bile and participating in its timely sufficient allocation in a duodenum, habitual current of bile changes. In certain cases normal supply of intestines with bile does not manage to be provided. The final mechanism of these violations is still insufficiently studied.
Can be the factors promoting development of a postkholetsistektomichesky syndrome the taking place of dyskinesia of biliary tract, the spasm of a sphincter of Oddi (muscular education in the place of falling of the general bilious channel into a duodenum) which remained after operation a puzyrny channel of considerable length. The expressed postoperative pain and a congestion of liquid in the field of the made operation can sometimes be the causes of this syndrome. Only in 5% of cases the reason of development of a postkholetsistektomichesky syndrome does not manage to be revealed.
Symptoms of a postkholetsistektomichesky syndrome
This simptomokompleks can be shown by preservation of the clinical manifestations taking place before operation, in a varying degree expressivenesses (most of which often were less expressed, but sometimes note also strengthening of presurgical clinic). Sometimes after a holetsistektomiya there are new symptoms.
The main symptom – painful. Pain can be as cutting, and stupid, various degree of intensity. Meets approximately in 70% of cases. The second for prevalence is the dispepsichesky syndrome – nausea (sometimes vomiting), swelling and abdominal murmur, an eructation with bitter smack, heartburn, diarrhea, . Sekretorny violations lead to violation of absorption of food in a 12-perstny gut and to development of a syndrome of malabsorption. As a consequence of these processes serve hypovitaminosis, decrease in body weight, the general weakness, angulyarny stomatitis.
Also body temperature can rise, arise jaundice (the skler is sometimes shown only by a subikterichnost). The Postkholetsistektomichesky syndrome can take various clinical forms, being shown by a false and true recurrence of a kamneobrazovaniye of a holedokh, strikturama of the general bilious channel, a stenoziruyushchy papillit, adhesive process in subhepatic space, holepankreatity, biliarny gastroduodenal ulcers.
Diagnostics of a postkholetsistektomichesky syndrome
In some cases diagnosing of the developing postkholetsistektomichesky syndrome is complicated by the maleficiated, poorly expressed clinical picture. For receiving full medical care the patient in the postoperative period and in further life without gall bladder needs to show consideration for signals of the organism and to report unambiguously about the available complaints to the doctor. It is necessary to remember that the postkholetsistektomichesky syndrome is the state demanding identification of the reasons of its emergence and the corresponding etiologichesky therapy.
For identification of the states which led to development of a postkholetsistektomichesky syndrome appoint laboratory blood tests to find possible inflammatory process, and also the tool techniques directed to diagnosing of pathologies of bodies and systems as directly exerting impact on work of biliarny system and indirectly acting on the general condition of an organism.
The spiral computer tomography (MSKT) and magnetic and resonant tomography (liver MRT) most precisely visualizes a condition of bodies and vessels of an abdominal cavity, also informative technique is ultrasonography of an abdominal cavity. These methods can reveal presence of concrements in bilious canals, a postoperative inflammation of bilious ways, a pancreas.
At a X-ray analysis of lungs exclude diseases of lungs and a sredosteniye (which can be the cause of a pain syndrome), stomach X-ray with contrast substance can help to reveal existence of ulcers and impassability in digestive tract, a reflux.
For an exception of an origin of symptoms as a result of other diseases of a digestive tract, make an endoscopic research of a stomach (gastroscopy) and a duodenum (fibrogastroduodenoskopiya). Violations in circulation of bile reveal by means of a radionukleidny research – a stsintigrafiya. At the same time the specific marker which accumulates in bile is entered into an organism.
One of the most informative methods allowing to study a condition of channels of biliarny system is RHPG (an endoscopic retrograde pankreatokholangiografiya). During this research violations of current of bile come to light, note a condition of bilious ways, channels, Faterov's ampoules of a nipple, reveal small concrements, note the speed of release of bile. It is also possible to make a manometriya of a sphincter of Oddi and the general bilious channel.
During RHPG it is possible to carry out some medical actions: to remove the stones which are available in channels, to expand a gleam of bilious ways in places of narrowings, to make a sfinkterotomiya at a resistant spasm. However it is worth remembering that in certain cases endoscopy of bilious channels promotes developing of pancreatitis. For an exception of pathology of heart use the ECG.
Treatment of a postkholetsistektomichesky syndrome
Methods of treatment of a postkholetsistektomichesky syndrome directly depend on the reasons of its development. In case this syndrome is a consequence of any pathology of digestive organs, treatment is performed according to recommendations about therapy of this pathology.
Treatment, as a rule, includes the sparing diet: observance of a diet – food in the small portions of 5-7 times a day, the lowered daily content of fats (no more than 60 grams), an exception of fried, sour products, spicy and spicy food, the products having bile-expelling activity, irritating mucous membranes of elements, alcohol. At the expressed pain syndrome apply to its knocking over , . Medicines are appointed by the gastroenterologist according to the principles of drug treatment of the main pathology.
Surgical methods of treatment are directed to drainage and restoration of passability of bilious channels. As a rule, the endoscopic sfinkteroplastika is carried out. At inefficiency make diagnostic operation for detailed studying of an abdominal cavity regarding probable causes of development of a syndrome.
Prevention and forecast
As prevention of a postkholetsistektomichesky syndrome it is possible to note measures for timely detection of various associated diseases able to serve as the reason of development of violations of circulation of bile: full and careful comprehensive examination of a liver, pancreas, biliary tract, a digestive tract, vascular system of an abdominal cavity by preparation for operation.
The forecast of treatment from a postkholetsistektomichesky syndrome is connected with treatment from the main disease which served as the simptomokompleks development reason.
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