DIAGNOSTIC AND TREATMENT ALGORITHM FOR PATIENTS WITH POSTCHOLECYSTECTOMY SYNDROME

Abstract


Aim. To develop diagnostic and treatment algorithm for patients with postcholecystectomy syndrome (PCES) based on integral assessment of clinical, laboratory and instrumental studies. Materials and methods. While carrying out multifactor analysis of clinical, laboratory and instrumental studies in 164 patients with PCES, the most significant evaluation signs were singled out. Score assessment system to divide patients into 4 groups was worked out. Results. This gradation was found to correspond to Roman consensus for patients with Oddi’s sphincter dysfunction. Patients of group 1 were indicated surgery. Patients of groups 2, 3 and 4 require estimation of bile outflow by means of hepatobiliscintigraphy (HBSG). Some patients had normal bile outflow, but in 68% of patients it was quickened, so there is Oddi’s sphincter failure. To make the reason of clinical manifestations more precise, computer tomography and magnetic resonance cholangiopancreatography was applied. Algorithm of diagnosis and choice of medical tactics was developed on the basis of integral estimation of the results of investigations. Conclusion. The developed algorithm for patients with PCES makes determination of sequences of studies and choice of medical tactics easier. HBSG allows to objectively estimate the state of bile outflow which in most cases is not disturbed and even quickened. After cholecystectomy, it is necessary to exclude other causes of patients’ sufferings and take them into consideration when performing repeated surgeries.

АЛГОРИТМ ДИАГНОСТИКИ И ЛЕЧЕНИЯ БОЛЬНЫХ ПОСТХОЛЕЦИСТЭКТОМИЧЕСКИМ СИНДРОМОМ

M V Repin

max_repin@inbox.ru

A V Popov

V Yu Mikryukov

T E Wagner

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