International Medical Journal, Vol. 27., Iss. 1, 2021, P. 31−35.
WAYS TO IMPROVE DIAGNOSIS OF PATIENTS WITH POSTCHOLECYSTECTOMY SYNDROME
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Postcholecystectomy syndrome is a symptom complex that occurs or worsens after cholecystectomy and is a functional and / or organic disorder. It often complicates the post−surgery course of gallstone disease. The presence of symptoms of the disease indicates a deterioration in the quality of life of patients, but the diagnostic examination is not always possible to detect morphological or functional changes. Thus, at present the syndrome is an urgent problem of gastroenterology and biliary surgery. Diagnostic issues with a differentiated approach to the functional or organic nature of postcholecystectomy syndrome are important for the choice of further treatment tactics. In order to improve the diagnostic algorithm taking into account the changes in the area of the major duodenal papilla, a study was conducted in 137 patients. To determine the functional disorders of the sphincter of Oddi there was used the method of ultrasound investigation of hepatobiliary area and Vater's papilla with choleretic loading on Boyden as well as the Grigoriev's methods in the absence of organic obstruction of the terminal choledochus at previous stages of examination. Morphological changes in the major duodenal papilla area were evaluated using the technique of parietal ph−impedancemetry, which was performed on the background of benign mechanical jaundice in the patients after cholecystectomy during endoscopic retrograde cholangiopancreatography prior to endoscopic papillosphincterotomy. The obtained results help to perform a differentiated approach to the patients who underwent cholecystectomy, taking into account morphofunctional changes in the area of the major duodenal papilla and allow the implementation of the selected methods to the research algorithm of patients with postcholecystectomy syndrome.
Key words: postcholecystectomy syndrome, functional and organic changes of major duodenal papilla, patency of the terminal choledochus, treatment tactics.
1. Grigor'eva I. N. Zhelchnokamennaya bolezn': eshche odin komponent metabolicheskogo sindroma? // Meditsinskii sonet. 2012. № 9. S. 92−93.
2. Zvyagintseva T. D., Chernobai A. I. Patogeneticheskaya korrektsiya biliarnoi boli pri postkholetsistektomicheskom sindrome i disfunktsii sfinktera Oddi // Suchasna gastroenterologіya. 2012. № 6 (68). S. 81−92.
3. Postkholetsistektomicheskii sindrom s pozitsii khirurga i gastroenterologa / N. N. Veligotskii i dr. // Ukr. zhurn. khіrurgії. 2018. № 2 (37). S. 16−21.
4. Gubergrits N. B., Yur'eva A. V., Fomenko P. G. Postkholetsistektomicheskii sindrom. Ch. І. Opredelenie, klassifikatsiya, patogenez, varianty bolevogo sindroma // Suchasna gastroenterologіya. 2008. № 2 (28). S. 70−80.
5. Zackria R., Lopez R. A. Postcholecystectomy Syndrome. [Updated 2020 Dec 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539902/.
6. Diagnostika disfunktsii sfinktera Oddi i diskinezii dvenadtsatiperstnoi kishki u bol'nykh s postkholetsistektomicheskim sindromom / M. V. Repin, A. V. Popov, V. Yu. Mikryukov, V. N. Repin // Annaly khirurgicheskoi gepatologii. 2014. T. 19, № 3. S. 74−80.
7. Klinicheskie rekomendatsii Rossiiskoi gastroenterologicheskoi assotsiatsii po diagnostike i lecheniyu diskinezii zhelchevyvodyashchikh putei / V. T. Ivashkin i dr. // Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2018. № 28 (3). S. 63−80. doi: 10.22416/1382−4376−2018−28−3−63−80