Postcholecistectomy syndrome of viznachennya. Postcholecystectomy syndrome: causes, symptoms, diagnosis and treatment

- a specific symptom complex, reassurance of the transferred cholecystectomy and by tying the function of the jaw-visual system with the help of cym. Prior to the manifestation of postcholecystectomy syndrome, recurrent painful attacks, dyspeptic disorders, diarrhea and steatorrhea, hypovitaminoses, and a decrease in muscle mass occur. To identify the causes of the syndrome, ultrasound and MSCT are performed black empty, Fibrogastroduodenoscopy, RHPG. Treatment of postcholecystectomy syndrome can be conservative (spasmolytic and enzymes) and surgical (drainage of the gut ducts, endoscopic sphincteroplasty and in.).

ICD-10

K91.5

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Postcholecystectomy syndrome - tse complex key symptoms To develop into an operational vision of the zhovchny mikhur. Until a group of patients with postcholecystectomy syndrome do not have ailments, those who have had cholecystectomy with abnormalities, have lost stones in the gut ducts, developed into an operative pancreatitis, and have superficially developed chills.

Postcholecystectomy syndrome develops in the middle in 10-15% of patients (with a total in the small groups, the indicator reaches 30%). In cholovikiv wines, it is practically twice as fast to develop, not in women. The postcholecystectomy syndrome can develop immediately after an operative visualization of the cheekbones is carried out, and it can manifest itself in a trivial hour (a few months, rocky).

cause

The main pathogenetic factor in the development of postcholecystectomy syndrome є collapse in the bilar system is pathological circulation of zhovchi. When you see the zhovchy mikhur, it’s a reservoir for playing with the stove, and take care of the abundance of time in the gut, the zvichy current of zhovchi change. In deyakikh vipadkah normal bowel postchannya zhovchyu not to go into trouble. Residual mechanism of cichus is damaged by lack of implantation.

Factors causing the development of postcholecystectomy syndrome, there may be some significant disks, spasm of the sphinkter Odd (myasis in the depression of the gut duct) Some of the reasons for the diagnosis of the syndrome can be caused by the operative bill and the purchase of the period in the region of the operation. Only in 5% of cases the reason for the development of postcholecystectomy syndrome cannot be affected.

Symptoms of postcholecystectomy syndrome

Danish symptom complex can be manifested in savings key manifestations Before the operation, in this very world of rotation (most often the fewer turns, but only some of them mean and the strength of the preoperative clinic). New symptoms are detected in some cases of cholecystectomy.

The main symptom is pain. Bіl can be yak rіzhuchoї, so і stupid, of a risky step intensity. Occurs in approximately 70% of the populations. Others for the widening є dyspeptic syndrome - nudity (inodi bloating), hypoxia and gurgling in the abdomen, haircuts with a strong dullness, stove, diarrhea, steatorrhea. Secretory damage to the development of malabsorption syndrome until the loss of moisture in the 12th intestine is damaged. A taste of these processes is to serve as hypovitaminosis, decreased weight, backward weakness, angular stomatitis.

Also, the temperature may increase, the temperature of the sclera may appear (sometimes it appears only by the subterranean nature of the sclera). Postcholecystectomy syndrome can be diagnosed with developmental clinical forms, manifested by pompous and true relapses of choledochus stones, stricture of the posterior gut duct, stenotic papillomas, adhesions of the prostate cancer, subhepatic

diagnostics

In a number of diagnostics, the postcholecystectomy syndrome develops, but it is complicated by a smooth, weakly twisted clinical picture. In order to deny secondary medical assistance to a patient in the period of operative operation and in a general life without a chewing micur, it is necessary to respectfully set before signals to his body and unambiguously about the appearance of scarring. It is necessary to remember that the postcholecystectomy syndrome is a tricky one, which can help determine the causes of its diagnosis and general ethological therapy.

For the development of the disease, they brought up the development of the postcholecystectomy syndrome, the laboratory pretreatment of the blood, the development of a powerful ignition process, organism.

spiral Computer tomography(MSCT) and magnetic resonance imaging (MRI of the liver) as accurately as possible visualizes the body of organs and vessels of a black empty, as well as an informative method of ultrasonic scanning of a black empty. These methods can detect the presence of calculi in the gut ducts, during the operation of the gum paths, and the gallbladder.

Treatment of postcholecystectomy syndrome

The method of treatment of postcholecistectomy syndrome bezposredno lie down for reasons of its development. That one has a lot of things Denmark syndromeє There is a lot of pathology in the organs of etching, and the treatment is followed up to recommendations for the therapy of this pathology.

Likuvannya, as a rule, includes a sparing diet: taking into account the mode of eating - 5-7 times a day in small portions, reductions in addition to fat (not more than 60 grams), including greases, sour products, spices, volodyut zhovchoginnoy activity, drastic mucus shells of elements, alcohol. In case of severe pain syndrome, drotaverin, mebeverin should be used for stopping pain. Likarski zasobi to be recognized as a gastroenterologist according to the principles of drug treatment of the main pathology.

Surgical methods of treatment are directed to drainage and renewal of the passage of the ducts. As a rule, endoscopic sphincteroplasty is performed. In case of ineffectiveness, a diagnostic operation is performed for a detailed implantation of a worm on the subject for other reasons development of the syndrome.

Prevention and forecast

In the context of the prevention of postcholecystectomy syndrome, it is possible to come in as soon as possible. fellow sickness, Which can serve as a reason for the development of the destructive circulation of the zhovchi: outside the complex, the lining of the stove, the creeper, court system black emptying during preparation before operation.

The prognosis of the disease is from the postcholecistectomy syndrome of dressings from the disease from the main disease, which was the reason for the development of the symptom complex.

Postcholecystectomy syndrome is an illness, which includes a whole complex of different clinical manifestations, which occurred at the last surgery, the essence of which was in the hanging of the ruminant, or in addition to the concretions from the daughters.

Yak starting mechanism in the form of destructive circulation of the zhovchi when seeing the zhovchy mikhur. Also, clinicians see a number of other reasons, which, in the middle, do not remain inadequate for cholecystectomy.

A clear picture of such a disposition is nonspecific, and it can be seen in recurrent pains in the abdomen and in the area under the right ribs. In addition, it helps to reduce the amount of oil and weakness to the body.

Diagnostics is direct to health wide range laboratory and instrumental problems, which, in the general order, are guilty of overdosing the history of ailments for establishing the fact that had been transferred earlier than cholecystectomy.

Likuvannya increase to dictate the importance of overcoming ailments, which can be both conservative and surgical.

International Classification of ailment of the tenth glance should be entered for a specific pathology of an okremiy cipher. The code for postcholecystectomy syndrome according to ICD-10 is K91.5.

Ethiology

The residual pathogenesis of the development of such ailment is lost until the end, we do not vivify, protest, but the main reason for the appearance of the wrong process of circulation of the beetle, such as vinicum on the smallest surgical visibility of the ruminant mechanism, in the localized Such a pathology is diagnosed in 10-30% of situations after previous cholecystectomy.

Among the factors, scho, as well as the postcholecystectomy syndrome, it is accepted to see:

• I am not good at preoperative training, but I am unable to adequately treat cholecystectomy;
• lack of diagnostics;
• unqualified operation - sometimes it is possible to introduce improperly introduced drainages, injuries to the jaws of the rump mink, or to the jaw-dropping nobles, as well as frequent concretions;
• Decrease in the amount of alcohol and milk acids;
• chronic incapacitation of the organs of the herbal system;
• penetration of ailments, which are negatively driven into the damage to the intestinal tract;
• microbial lesion of the 12th intestine and other organs in the intestinal tract;
• partial stenosis or obstruction of the Vater papilla of the duodenum.

Besides, there may be pathologies that have been formulated before or after the operation. To such a disease is varto bring:

• dyskinesia of the sphinkter Oddi i;
• abo;
• spike processes, localization of pechinkoyu;
• diverticulum and fistula;
• abo;
• papillostenosis;
• the adoption of the brush in the zagalny zhovchny prototype;
• іnfіkuvannya zhovchnyh ducts.

It is obvious that in about 5% of patients, the reason for the appearance of a similar illness does not seem to be possible.

Classification

The term "postcholecystectomy syndrome" includes a number of pathological conditions, and itself:

• the destruction of the normal functioning of the sphinkter Oddi;
• Help on the education of calculi in zhovchnyh shlakh, post-cholecystectomy;
• pomilkov for repeated accusations of stones, for those who are disobedient;
• stenosing by a duodenal broach, i.e., a stenosis of the great duodenal papilla;
• active adhesion process with localization in the subhepatic space;
• Chronic progression of cholepancreatitis - just overnight the battle of young men and women is fired up;
• gastroduodenal inflections or any defects that damage the integrity of the mucous slurry or the duodenum, which may cause a decrease in glybin;
• cicatricial ulceration of the posterior zhazhnoy duct;
• Dovgoyu kuksi syndrome, that is, part of the duct, surgical engagement;
• persistent pericholedocheal.

symptomatology

Unimportant to those who postcholecystectomy syndrome, there is a great number of clinical manifestations, all the stench is nonspecific, which cannot be accurately inflicted on the interruption of the disease itself, but also to accelerate the process of establishment.

Oskilka the head symptom of the ailment is the pain syndrome, then the clinicians accepted the distribution of it into a number of types:

• zhovchny - occasionally appear in the upper part of the abdomen or the area under the right ribs. It is not easy to see the irradiation of pain in the back zone and in the right scapula;
• pancreatic - localize closer to the left edge and widen to the back. Besides, the decrease in the intensity of the symptom is indicated when the tulub is nailed forward;
• knowledge - often have an operational character.

In the absence of an ethological factor, a symptomatic picture of a similar pathology includes:

• Rapid recognition of the most powerful attacks - in the most important situations, there are about 20 damages and it can be repeated with a stretch of decimals. It is not common for such a pain syndrome to appear when the patient is implanted at the end of the hour;
• disallow the act of defecation, how to turn around in the great number of diarrhea - positively can reach 15 times for dob, feces with a watery consistency and a stinking smell;
• gas supply;
• improvement of the size of the front wall of the black light;
• the appearance of a characteristic grumble;
• the form of cracks in cocks mouthwash;
• weight reduction - can be light (from 5 to 8 kilograms), more important (from 8 to 10 kilograms) and important (from 10 kilograms up to extreme weight);
• weakness and swelling stomatomy;
• post-sleep drowsiness;
• decrease in preference;
• attack nudoti, scho end with bluesy poses;
• fever and chills;
• spasm and almost trivialities;
• girky dreamer at roti;
• seeing great sweat;
• rosette;
• і haircut;
• zhovtushn_st of sclera, mucous and shk_rnyh curvatures - such a symptom of postcholecystectomy syndrome develops to grow up to death.

In case of a diagnosis of such a disease in children, the symptomatology will increase in the number of symptoms mentioned.

diagnostics

A doctor-gastroenterologist is responsible for the laboratory and instrumental conditions, as well as for the initial diagnostics. It is not complex diagnostics to repair the following procedures by the clinician:

• vivchennya іstorії ailments - for the joke of chronic ailments of the intestinal tract or the liver, to give chances for the development of PCES;
• analysis of life and family history;
• retreat physical look, which transfer to palpation and percussion of the front wall of a black empty, I will estimate the most recent viglyadі shkіri patient, as well as vimіr temperature indicators;
• a more detailed experience of a sick person - for the folding of a more symptomatic picture and the establishment of a degree of turn of key signs.

Laboratory diagnostics of the field in health:

• biochemistry of blood;
• zagalnoklinicheskogo analysis of blood and urine;
• microscopic doslijen feces;
• analysis of feces for egg worms.

Highest diagnostic value may come up with instrumental procedures:

• X-ray and ultrasonography;
• MSCT queue;
• CT and MRI;
• scintigraphy and gastroscopy;
• FGDS і RHPG;
• manometer and sphincterotomy;

lykuvannya

As a rule, the therapy of postcholecystectomy syndrome can be either conservative or surgical in nature.

Inoperable treatment of ailments in Pershu Chergu is aimed at storing such medications:

• drugs in nitroglycerin;
• spasmolytic and insensitive;
• antacids and enzymes;
• antibacterial speech;
• Vitamin complexes;
• immunomodulator;
• adaptogen

The main reason for usuned ailments is introduced in case of postcholecystectomy syndrome, according to the rules:

• living in small portions;
• number of meals for up to 7 times;
• bagachennya menu with grub fibers, vitamins and living microelements;
• mainly from greased and gostrich stravs, healthy and confectionery virobes, cold fat and lard, fatty meats, poultry and ribs, such as processed foods and smoked meats, marinades and vegetables such as caviar, frosty spirits
• living in a great variety of food varieties of meat and ribi, legumes and rosaceous cereals, green and non-acid berries, vegetables and fruits, non-fat dairy products and wheat blends;
• preparing herbs in the most sparing ways - cooking and steaming, cooking and cooking, without eating fat and without removing golden skins;
• clear nutritional regimen;
• control over the temperature їzhі - you won’t be guilty of being very hot or overwhelmingly cold;
• construction to the minimum

The basis for the therapy is taken sparingly menu №5.

Do not involve in the process of PHES therapy of physiotherapeutic procedures, in the middle:

For consultation with an elusive drug, it is allowed to use non-traditional methods of therapy. People will start cooking looking for views based on:

• calendula and dried flowers;
• valerian and hop cones;
• centaury and root ayru;
• corn rilets and cleanliness;
• bird knotweedі quotes of chamomile;
• Beast and roots of Oman.

Chirurgical treatment of postcholecystectomy syndrome of polygons in the long term formed in the general period in the last few hours before the operation of concretions or scarring, as well as in the drainage of

may you expedite

Ignoring key signs is a sign of wrongdoing for repeated medical aid I will block it with a branch:

• excess bacterial growth syndrome;
• visnazhennya abo;
• deformation of the skeleton;
• at the choloviks;
• damage to the cycle of menstruation in women.

Krym, do not include the possibility of verifying such operations expedited:

• robustness of operational seams;
• іnfіkuvannya wounds;
• the formation of abscesses;

Prevention and forecast

The main prophylactic visits, scho to advance the development of similar illnesses, are taken in respect of:

• retaliation diagnostics and preparation of the patient before cholecystectomy;
• time-consuming appearance and weakening of gastroenterological ailments or pathologies of the liver, which can provoke PCES;
• correct and balanced harvesting;
• povna vidmova vid shkіdlivyh ringtone;
• regular prophylactic examination in a medical facility.

The prognosis of the postcholecystectomy syndrome should be dictated by ethiological factor By provoking the development of a similar symptom complex. However, in the overwhelming majority of situations, a successful result is promoted, and the development of an accelerated rate is estimated approximately in a 5-skin patient.

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It is more efficient to improve the efficiency of the overwhelming majority of ailments in the housing and communal services and to improve the quality of services. However, for some people with ailments, I won’t make it to the point of being polished, but for some people, operations will become the cause of new, not less important, ailments. For the operative treatment (involvement) in the sick, a number of symptoms of illness do not often occur, such as bullets before the operation, or they appear new.

Such a camp of the ailments is characterized by good-for-nothingness, the range of symptoms, which are called postcholecystectomy syndrome (PCES). The problem of diagnostics and the development of PHES continues to become even more urgent. The price is overwhelmed by the uninterrupted increase in the number of ailments, such as suffering from gallstones and painful symptoms of cholecystectomy, serious difficulties in diagnosing this syndrome. Yogo essence is an unmistakable character, which means a sum of a different kind of destructiveness and acceleration, as they occur during operations on the galls and especially cholecystectomy. PHES develops through accelerated abnormal diseases of other organs.

Because of the term, relying on respect is also a pathological camp, which is not the least bit connected with a viconious operation [E.I. Galperin, 1976; E.V. Smirnov, 1976; І.І. Goncharik, 1980; F.R. Burton, 1992]. The whole syndrome is often found in the result of admitted diagnostic, tactful and technical pardons before the first operation [B.V. Petrovsky and spivavt., 1980; Sauerbruch, 1992]. The frequency of occurrence of such symptoms of ailments and acceleration (pain in the epicranial area, cholangitis, stenosis of the ovarian mucosa, "forgotten" or new stones, etc.) for carrying out the HKH drive operations to become 10-20% [B.M. Chernov i spivavt., 1996; Botny et al., 1993, and the operation with the HBH drive is close to 30% [V.M. Sitenka і A.I. Nechay, 1974].

Extensions in the surgical literature of the term PHES show, head cause diagnosis of the syndrome є gallbladder waste, cholecystectomy є not physiological involvement, and the reason is quiet pathological changes, They develop in the cheeks and organs. However, unaffected by the author's actions [P. Malle-Gi, Kestene, 1973] it is fair to say and call it a syndrome due to cholecystectomy.

Often here there is a "winnie" not so visible zhp, although chronically atypical progression to the disease of the liver, pancreas, shlunka, duodenal ulcer and navit, which means author, spondyloarthrosis. From the point of view of the term PHES sound not so far away, the splinters do not expect that the ZhP will become the reason for the accusation sickly stanіv... It has been established that 60% of the ailments suffer from operative damage to the accumulation of redundancies in the gut ducts, before the first operation, stones, uninvolved and non-destructive diseases of the bilious pancreatic system. According to the literature, the frequency of excess stones in the gum ducts (residual) becomes 2-10% [V.N. Klimov і spіvavt., 1982; E. Usche et al., 1993].

Diagnostics are found in the hepatopancreatoduodenal area of ​​the anatomical and functional changes during the operation on the chewing ducts is very difficult. For diagnostics of cich changes in the end of the rock with success, more informative methods of EI are used, zokrem retrograde cholangiopancreatography, CT and ultrasound. Tsi methods of advancement give even more value for diagnostics.

It became possible not only to speed up the number of repeated surgeries in cases of rapid progress, but also to reduce mortality (7%). Falling down on the causes of the diagnosis of PCES, there are problems: mechanical transition in the gut ducts, ignition processes in the organs of the gspatopancreatoduodenal zone, the incidence of other organs and systems.

PHES lasts for two groups, summarized:
1) congenital cholecystitis (CP, hepatitis, I B, CP);
2) technical and tactful pardons, allowing for the hour of the operation, as well as functional damage nervous system and dysfunction of female nobles [A.I. Krakivsky and spivavt, 1978].

Repeated surgery will require ailments of only another group, in some patients with chronic diseases in the main cases of redundancy (residual) in the gallbladder, or repeated (relapse) of stones, fatal contractions, and fibrosomal diseases of the choledochus region , as well as zovnіshny zhovchny noritsy, overwhelmingly overwhelmingly (more than 1 cm) ducts, post-traumatic cicatricial ulcers, incompletely visible VL, adhesions in the black empty, fired by near-icy colds lymphatic universities(Pericholedocheal lymphadenitis) [V.T. Zaitsev, 1982; S.S. Balalikin, 1986].

The cliché picture of PHES is mainly summed up by the destructions of the natural result of the destructions and the destructions characteristic of the new ones (pechinkova kolka, zhovtyanitsya, sverbіzh shkiri). Clinical symptoms of PCES are often present in patients with ailments before surgery. In addition to pain syndrome, it can be manifested in vigilance of female abnormal pancreatic colic, characteristic and clinical manifestations of bilious hypertension, symptoms of MH and cholangata, etc. Become localized in the upper right square of the black empty space.

Our caution and the date of literature show that the development of PCES is summed up by a number of susceptible factors (destruction of cholesterol exchange, development of a pathological process, new anatomical and physiological reasons). Mansurov, 1982].

Seemingly, cholecystectomy, viroblen with the drive of the HKH, not ailing ailments of obsessional damage, dyscholia. Some damage occurs due to cholecystectomy.

Moreover, in the presence of cholecystectomy, the majority of the sick have a litogenic, low cholesterol efficiency. In addition, when a person is seen, they are reflexive and humoral injected from their side onto the sphincter of the ampoule of the liver and pancreatic disease and for cholecinesis, and the fall of the role of supervising the damaged people of the mother, who is poisoned The bactericidal power of the gut will decrease, as a result of which the microflora of the duodenum expands, the growth and intensity of intestinal microbes will weaken, the malignancy of gum acids and other components of the gut in the liver-intestinal zone will be destroyed.

Under the infusion of pathogenic microflora of gum acid and deconjugation, it is possible to produce up to the burning of the intestinal CO, the development of reflux gastritis, duodenitis and colitis. There are duodenal dyskinesia, hypertension, duodenogastric reflux, vortex duodenal strum in place of the choledochus and the pancreatic duct [PL. Grigor'ev, E.P. Yakovenko, 1993]. Reactive pancreatitis and hepatitis occur on the whole until the sphincter duct is damaged.

Thus, the development of PCES from the very ear is tied to the damage of the hollow warehouse of the heart, the growth of the disease in the PDK, the functional function of the sphinkter of the hepatopancreatic ampulla (discinesia), and the decrease in the decrease in the amount of acid, the disruptive process can be viewed in the equation systems.

Causes of PHES development. Often times, the cliché picture is not clearly rotated, and also the lack of information in practical solutions in tsiy galuzy to produce enough factors to become unintelligible. The reasons for the development of pain syndrome are caused by cholecystectomy to spread into two groups: pain syndrome, dressings with an operation, and not a connection.

Up to a group of repeated pain syndrome associated with the operation, there is an incompletely visible appearance of new ovarian stones, excessive stump of gallbladder, or cicatricial cicatrices, cicatricial stenosis of the hepatobiliary duct, stenosis of the hepatobiliary duct, stenosis of the hepatobiliary duct, stenosis of the hepatobiliary duct, stenosis of the liver winykis pislya CDA, zakrittya (obliteration) BDA, CP, chronic cholangiohepatitis, duodenobilary dyskinesia, paracholedocheal lymphadenitis, adhesion process of black emptying.

The reasons for the pain syndrome, but not a link to the operation, chronic gastritis, Sechokam'yana ailment, malignant plump of shlunka, good guys Pancreatic cancer, ductal cancer and liver polychistosis.

It is recommended to uncover such oversights that it should be recommended before the hour of skin surgery on the female paths [during the period of time of the skin surgery]. Petrovsky and spivavt, 1980].

Nemaє sumnіvu, scho stosuvannya methodsіv diagnostics gostry i chronic cholecystitis and further into the detailed operative treatment to lead to greater successes in the surgical treatment of the ailments from the ill-health of the zhivnoy system.

At the presentation of key tributes, it was brought to the point of kuksa PP (stone in the cult of any fiercely hot) There is no particular role in the diagnosis of PHES and nutrition about the "new mikhury", but a great cult among the great majority of people. A number of authors [P. Malle-Gі, 1973 і ін.], Among the causes of PCES dystonia of the sphinkter Oddі become 0.2%.

The osvita of stones in the gut ducts is often tied to an accelerated outflow of gum (cicatricial stenosis, hypertension of the sphincter Oddi, sclerosis of the pancreas head, etc.).

Residual ZhP for a large kuksa PP, especially with the presence of stones in them, є the reason for the illness of the sick and the visibility.

A number of authors see these thoughts, when they write cholecystectomy when there is a large flow of women in the duodenum, they do not see an enlarged duct. Remain only in quiet places, if the transition to the current state does not know the hour of the operation, for the moment of the operation is not known.

At the ligament of the cym in the presence of a swollen enlargement of the duct and pain syndrome, it is shown to be repeated promptly involved, Meta yakogo - revіzіya zhovchnykh ducts i usunennya vyavlenіkh pereshkod. Due to cholecystectomy, it is shown to important accelerated problems є “scarring” of the duct, as in a large number of cases, as a result of the reduced duct per hour of operation.

The reasons for the development of pathological staging for operations on the female paths and cholecystectomy are divided into three groups: the organic damage of the female paths, the diseased organs of the hepatopancreatoduodenal zone and the damage to the other systemic organs.

To the group of organic problems of the female ducts, the following is reported: “lost stones” in the clearing of the female ducts, the sound of the BDS, the lack of the sphinkter Odd, the scarring of the sound of the female ducts, the excessive life and the result of the poor shlyakhiv, cholangit.

Injury of organs in the hepatopancreatoduodenal zone: chronic hepatitis, dyskinesia of the galls, chronic hepatitis and CP, swelling of the bilopancreatic system, paracholedocheal lymphadenitis.

Disorders of other organs and systems: twisting of the ductus and duodenum, gastritis, duodenitis, swelling of the shlunk and intestines, chronic colitis, piddysmal hernia, duodenal dyskinesia, reflux esophageal (OC), diencephalic syndrome.

The first group of reasons is related to a technical defect, as well as to the lack of prerequisites of the gum duct before the hour of the operation. Only the causes of the group are without the middle, or bit by bit, with the cholecystectomy transferred to the last.

The rest of the group of reasons is tied to the defects of the pre-defined conditions of the ailments and the non-manifestation of diseased organs of the etching.

Anxiety of other organs and systems will make them appear in the operational period.

Often the cause of PCES is the excessive amount of stones in the ducts, and it is difficult to find it in the main with the lack of and uncommon intraoperative revision, if the operation is not frequent during the last hour of the operation and additional special methods of hirurga.

The reason for the development of PCES may be due to the fact that it is also "buried" in the education of the ducts and incrustated drainage [A.I. Krakivsky and spivavt, 1978], which can be made to the point of failure.

The cause of PCES can be caused by an operative duodenitis, which supervises damage to the rupture and evacuation functions of the duodenum, dyspeptic symptoms, and seems to be important and pains in the epigastric area.

When you see a gallbladder in the middle of the term, symptoms of reactive pancreatitis can be seen, with which there is a pain of an operative character, supernatant dullness, grist in the mouth, and flatulence. The manifestation of the activation ignition process in the upper viddylah of the slunk-intestinal tract, strangulation of the excretory function of the pancreas, etc. Cholangitis, choledocholithiasis, cicatricial inflammation of BDS, etc. are often the cause of PCES.

Often there is also a fiery zhovchny shlyakhiv (cholangit). The operation is performed in case of the presence of internal fistulas and BDA. Cholangitis is a permanent companion of obturation of stones in the gut ducts and cicatricial inflammation, and it manifests itself in a hyperexia of the gallbladder's way, and in more important cases of phlegmon of the gall's galls.

When the rest of the zhovch is muddy, it thickens in the kintsev rakhunka, it swells with a gnarly character. In the parenchyma of the liver, a lot of destructive fires, gnaries, etc. are formed. In case of a vigorous development of the ignition process, as a result of cicatricial changes in the galls, there can be a blistering, fibrous degeneration of the liver and a biliary CPU.

development:
1) gostry;
2) chronic relapse;
3) primary sclerosing cholangitis.

In the pathogenesis of hospitable cholangitis, the main role is played by the formation of an obliteration of the gut ducts, as a result of which the grip is rapidly growing in them, the massive penetration of microbes and toxins in the gums is increased. The reason for the development of cholangitis is often kishkova palichka, Staphylococcus, streptococcus, anaerobic microbes, bacteria, etc. [V.І. Kochorovsts і spіvavt., 1984; M.W. Laung et al, 1994]. Infection can also be widened by a hematogenous path, protesting often goes through the BDS.

The stage of the turn of the clinical symptoms lays down as seen in the walls of the gut ducts of the morphological changes. Falling down the steps of the turn of the cholangitis evolves catarrhal, phlegmosis, severe and obstructive cholangitis. Catarrhal and phlegmanous cholangitis is manifested by changes in the temperature of the sickness, in the case of jaundice of the skin, pain in the right side of the dermal area, etc. Gniyny cholangitis can be a mother bliskavichny interruption, in the first few years the temperature rises to 40 C, grows septic shock, NP і etc.

With gross cholangitis, many others or some great gnaries occur in the liver. The process of slowing down is manifested by pain in the right side of the area, chills, feverishness, hectic type of temperature, clear symptoms, liver disease and swelling ailment in the right area. In blood, leukocytosis with neutrophilic disease is indicated. There are a lot of urobylinu at this bitch.

To develop on aphids of choledocholithiasis and cicatricial stenosis, the cholangitis duct can be recurrent in nature. Skin relapse is manifested by the periodic appearance of zhovtyanitsi and chills, which are known when renewed with zhovchі. When the formulation is formed, there are signs of destruction in the blood and slaughter, hypersleukotsitosis, destruction of the leukoformula, toxic granularity of neutrophils. Hyperbylirubinemia and dysproteinemia are indicated.

In case of important forms of gastric cholangitis, NP can develop. There is a feeling of seriousness and pain in the right pediatric region. There are important manifestations of intoxication, zhovtyanitsa. As soon as the zhovchni shlakhi obturuyutsya, then the feces will be burnt. Trivial obstruction of the young men’s nobles, to bring about this weakening, is not often the reason for the development of chronic cholangitis and sclerosis of the young men’s nobles.

Chronic recurrent cholangitis is uncomfortable. Wine develops in case of partial obturation and stenosis of the female paths and in the minds of the presence of BDA, if there is reflux in the intestine. With a trivial interruption of such cholangitis, bilarial CP often develops.

Chaledocholipiasis. Yak vіdomo, the main mice of stone maintenance є ZhP, the smelly stench is consumed in the OZhP [K. Niderle і spіvavt., 1982; A. Sobanski, 1986]. About the price chemistry warehouse to be found in the gum ducts of the stones [S.Yu. Knubovich, 1981; A.G. Petrosyan, 1984]. The initial establishment of stones in the gut ducts is denoted as 3-5.7% of the stones [V.V. Vinogradov i spivavt., 1977; A. Sobanski, 1988].

For choledocholithiasis, recurrent pain attacks are characteristic in the right pediatric region, which is superficially accompanied by a back pain, cholangitis, shkіrnim sverlyachkoy, Chills and changes in temperature. It is also characteristic of the admission of the ryvnya to bilirubin and the appearance of recurrent manifestations of cholangitis. In some cases of choledocholithiasis, there can be contractions and without swelling signs.

BDS stenosis. Among the reasons for the loss of life is especially the problem of the loan of the BDS. Vono to become 55.4% of all those involved, vibrated in the common bile duct [AA. Movchun, 1984; B.V. Petrovsky and spivavt, 1986]. Razrіznyayut first and secondly ringing BDS.

Primary ringing of the ducts without changing the ducts. Secondary ringing of the vine on the ground, even the lasting changes to the hepatocholedocheal area [V.V. Vinogradov і spіvavt., 1973]. The following causes are accounted for by the following: a) post-traumatic sound; b) firing sound; c) sounding reflex walking. Post-traumatic scars are caused by injuries to the side of stones and ear inflicted on one hour of operations.

Reflex podvuzhennya is diagnosed with stones and chronic stoneless cholecystitis as a result of trivial spasm of VDS. Stenosis of OBD can also be diagnosed with diseases of susceptible organs [K. Fularton et al, 1992]. Most often (in 26-30% of ailments), cicatricial-igniting BDS and amlullary choledocholithiasis occur [B.V. Petrovsky and spivavt., 1980; RA. Mehrabyan і spіvavt., 1984].

Fired up the BDS (Panilla). It occurs in 27.5-75% of cases, mainly in cases of biliopancreatoduodenal zone disease [V. Lembke et al., 1994]. Paggillite is important (88%) in the operational period. The impairment of OBD in case of papilomas should lead to the appearance of hypertension in the gum and pancreatic ducts and the development of cholangitis. As a result of papillitis, sclerosis of the tissue of BDS develops, which in 7-39.3% of ailments is the cause of the formation of cicatricial papillostenosis [A. . Janaka et al., 1992].

Diagnostics. For the correct diagnosis of ailments of PHES, it is necessary to carefully examine the causes of both before the operation, as well as in the period of operation. Finding out the reasons for the development of PCES additional help with a clear history and the correct history of the history of the hepatopancreatic system. In case of pretreatment of ailments, there is a decrease in the amount of home biochemical methods in the development and activity of PS enzymes. For the whole group of ailments, it is necessary to use obovazkovim PI shKT, as well as contrastingly up to the level of zhovchny ducts. For zyasuvannya stun of the pancreatic duct is carried out RPHG.

For cholecystectomy, reactive hepatitis, colitis, intestinal dysbiosis and other pathological processes develop slowly classic paintings qih get sick. For the identification of the reasons for PCES, it is even more important є the establishment of methods of contrasting illnesses of young people. With the presence of a zhovchny fistula, an obovazkovy zrobiti fistulocholangiography is involved. It is still possible to clarify the reasons for the failure of the OZhP and the function of the fistula, if there is a level of failure, the moment the fistula is opened with the gut duct, and on the basis of the presentation of the tactics of the fistula.

For the diagnosis of a state of the art cholangitis, it is more important to consider clinical and laboratory information. It is especially valuable to take a contrast to the PI, as well as to achieve duodenal vstu. When PI krіm will zhovchnih shlyahіv, in addition chislі i papilla of Vater, bіlsh іnformativnim Je іnfuzіyna holangіografіya, endoskopіchna RPHG, cherezshkіrno-chrespechenochnayaholangіografіya, vnutrіshnovennaholangіografіya, ultrasound, CT, fіstuloholangіografіya, gepatografіya, magnіtno resonance tomography, holedohoskopіya i endosono-grafіya [AA Pіshkіn і spіvavt., 1992; Rigauts et al, 1992]. These methods of advancement give the ability to read and write about the standard system, especially before repeated operations on them and before the hour of the operation.

In the given hour in diagnostics of pancreatobiliary zone disease, especially for cholecystectomy, it is of great importance to rely on endoscopic RPHG.

Shown by the vikonannya tsiogo method of advice є:
1) relapse of non-sensible reasons, zhovtyanitsya;
2) I am sick upper half the abdomen, the causes of some buvaє it is difficult to clarify with the help of other methods of advancement;
3) apparently about cholelithiasis, abdominal pain.

RPHG is an effective and reliable method for diagnostics of a small character. There is a chance in the transition to a large number of pathological processes that occur in the gut ducts. Without zasosuvannya tsiogo method mayzhe is ill-advised to find out the cause of PCES.

Likuvannya. Lіkuvannya zhvoryuvan zhovchnyh gentry, which is the cause of PCES, has a number of peculiarities. It is even more important to establish the correct regimen for eating ailments (dietotherapy). The mode of harvesting is guilty of but differentiation, which lies in the hour that passes during the operation, the stage of the turn of the main manifestations of the PCES, the mass and the literal power of the woman.

Likarska therapy is focused on the correction and correction of discines and other manifestations of the sphinkter Oddi and DPK. The prophylactic PCES also plays an important role in the development of rationalization, especially in the early period of operation. In case of cholestasis, it is recognized that lipotropic diets (style No. 5) are used, as well as bilkami and lipotropic rechovins, such as fatty acids (vitamins B).

For the reduction of pain and dyspeptic symptoms with the help of the correction of the function of the sphincters of the duct and DPK, nitroglycerin, raglan, cerucal, sulpiride are used, and for adsorption. For the calming down of igniting manifestations, CO is used for dynod, vicair, etc., and for the suppression of the activity of pathogenic microfloria - enteroseptol, biseptol, furazolidone and erithromicin.

In case of holangitis, important health care institutions є: maintenance of infection, detoxification and improvement of health and regenerative health of the body, prevention of vitality in the flow of milk, etc.

In case of severe cholangitis, a call is made to drainage of female nobles, and periodic sanitation is carried out.

With the development of nonspecific reactive hepatitis, it is recognized as an esential, legal, lipamid, and in the presence of pancreatitis, it is also associated with pancreatic enzymes. To stifle the process of stonework and prophylaxis of tightly tied obesity, a low-calorie diet is prescribed. For the regulation of the chemical warehouse of zhovchi, preparations of zhovchi are recommended (lyobil, holonerton, ruganol). The preparation takes into account the normalization of cholesterol in the gum, the correction of the cholesterol efficiency, the lysis of the cholesterol stones, etc. As soon as PHES is accumulated with organochnyh zhvoryuvannym biliopancreatopapillary zone, it is shown to be re-operatively involved.

The main meta of repeated operations is the update of the vilniy vidtik zhovchі in the DP Do a choledohotomy or BDA. With the presence of cicatricial stenosis, or many other stones, putty-like mass, as well as with an excessive part of the gallbladder, or the presence of an overwhelmingly overwhelming coxi of PP, they see it.

The peculiarities of the repeated operation of the amazement with the change of topographer-tomic minds, the development of the great, is conveyed by the state path, which significantly advances the operation of the operation, zooms in the ability to win over technical and tactful pardons. Technical pardons related to the pockets of the ducts of the female ducts and susceptible organs and are determined as a result of the inappropriate preparation of the ailments and the choice of inadequate method of operation. Obligation of preoperative training for ailments from PHES key forms becoming ill, in a sick and concomitant pathological process. The nature of the repeated operation is based on the specific cause of the PCES.

If you have too much kuksi, PP, or if you see someone else, you see. In some cases, they see a part of the ZhP, overlapping a short kuksu PP. With a new cult of PP, a resection is carried out. The operation is absolutely indicated for hepatocholedocholithiasis, ulceration of the pectoral, posterior zhazhnoy ducts and OBD, as well as in the presence of CP [A.I. Krakivsky and spivavt, 1978; E.I. Galperin and spivavt, 1982].

As soon as the stones are stuck in the OZhP, it is not easy to see through the holsochostomy drainage tube behind the additional "Karzin" Dormia, a balloon catheter and other minor instruments. Small cholesterol stones can change in the size or increase the amount, and then, by the way, we warm up with a 0.25% novokaynu drop and introduced by the droplet method 40-60 yew. OD heparin vishtovhnyuti in the duodenum enlightenment. In parallel with cym, it is associated with antispasmodics (no-spa, atropin, plateafillin). In a number of stone types it is possible to visualize the duct with a special attachment.

In the rest of the rock, there is a wider expansion of the endoscopic method of visualization of stones for the education of young men. Management of choledocholithiasis in a given hour reaches 80-95%. We stayed for an hour to use the method of extracorporeal lithotripsy, especially in quiet cases, if it was not possible to see the stone by the endoscopic method [O.V. Sarukhanyan i spivavt, 1991; DB. Kolesnikov and spivavt, 1993; B.S.Briskin and spivavt, 1997; CD. Becker et al. 1987; K. Ukushima et al., 1992].

The price of bloodlessness will be displayed in 3-4 days. writing operations. With їkh ineffectiveness in 2-3 mіs. after the first operation is carried out again operatively. With the presence of residual and recurrent stones of the common bile duct, as well as stenotic pancreatitis, the repeated operation in a large number of cases is completed with internal drainage of the gut ducts.

When a transduodenal papillosphincterotomy is violated in the period of an operative period, especially when pancreatitis is evident, a transduodenal papillosphincterotomy is violated, as a more rational and physiologically adjusted operation [B.V. Petrovsky and spivavt., 1980; SA. Jones, 1978]. The frequency of this engagement becomes 30% of repeated operations [AC. Movchun, 1984].

In the rest of the rock in CLINIC PRACTICE We welcomed the visonuvati endoscopic palillotomy by the way of electrocoagulation. In the process of endoscopy (duodenoscopy), IT also appears.

Endoscopic papillosphincterotomy is indicated for viconuvati for:
1) choledocholitiaee, sounding of the terminal appearance of the OZhP;
2) primary and secondary (non-operative) stenosis of OBD;
3) stenosing palillitis or the manifestation of the hammered stones of the OBD. The managers of the storing method, as well as seeing the stones with the endoscopic method, are often used to remove the ailments from the empty operations.

If the correct vikonanoy endoscopic papillosphincterotomy is used, symptoms of mild hypertension develop, there are laboratory and clinical signs of MH, which significantly change the symptoms of CP, change or increase the amount of cold. Literary data to inform about those who endoscopic papillosphincterotomy є effective method lіkuvannya zhovtyanitsі, which are diagnosed as a result of stenosis of OBD, choledocholithiasis and other reasons.

In the case of post-traumatic ringing of the post-traumatic zhivchnyh nobles, apply BDA between choledochus and DPK or TC. In the last few hours of operations, vibrating from the drive of cicatricial stenosis of the OBD, a laser scalpel and special tools were started [AA Movchun, 1986; R. Saner et al., 1986], for the additional help of which, a bloodless development of BDS and "gluing" of BDS and choledochus is carried out, without overlapping seams (sphincteroplasty without seams).

In case of high constrictions of the OZhP, for the renewal of the current flow, a BDA is applied, and if it is unfeasible for the operation, it is necessary to carry out a recanalization of the sounding channel, which is overlaid on the whole place of chlorinated drainage. It remains to vivodit s Felker (Figure 38), or through the parenchyma of the liver. Drainage should be filled for 4-6 months.

Malunok 38. Drenuvannya OZhP by Felker

unsatisfactory results surgical treatment XX vyavlyayutsya stretching the first rock song of the opera. A dynamic dispensary, which helps to prevent ailments, will help you quickly find that they are damaged in the hepatoduodenal zone and to carry out the last trial lykarsky and health resort treatment, and, if necessary, repeat promptly as soon as possible. Such a reason gives the possibility of policing the results and the treatment of ailments.

In the preventive maintenance of PCES, we will borrow the operative maintenance of the ailments and promptly work with the housing and communal services, in the process of engaging in the process we will be obliged to carry out the additional maintenance of the female gates. More important it is also quickly and efficiently involved in housing and communal services. As the most favorable, so the results of the treatment of ailments are generally more agreeable and apparently less important, as the cholecystectomy is carried out in the early period, before the development of the disease is delayed.

Postcholecystectomy syndrome (PCES) is a pathology, as a result of cholecystectomy as a result of cholecystectomy. The price of clinical signs is amalgamated by the dysfunctional system of mental vision: the rapid health of the sphinkter Oddi, making it difficult for the nutritional fluid to enter the intestines.

Zhovchny mikhur is an empty organ, or a reservoir, in which the zhovch accumulates and concentrates, it is viroblyatised by hepatocytes. Periodically, the mikhur will speed up, zhovch along the ducts wicked into the 12th intestine, and take care of the fate in the etching process. The deyak's components will soak through the walls of the furniture back into the shelter, while their clientele see a number of words that are important for etching. If the chewing ministry is seen to shy away, the organism will start fixing and re-energizing the work of the whole herbal system. As well as adaptability to the organism of diminishing for some reason, postcholecystectomy syndrome develops. In people, pathology is developed twice as fast as in women. Zahvoryuvannya is not a neatly twisted vikovyh article frames. Children will be restructuring in the edge of the country.

PCHES appears to have an attack-like pain in the right pidreber'i, dyspepsia, style breakdown, signs of hypovitaminoza, skinny conditions. Skin of quarters of ailments, which has suffered from cholecystectomy, presents a subset of scarg... Diagnostics of pathology primed on ultrasound, FGDS, CT of black emptying. Lіkuvannya polyaga in dotrimanny children, how to spare, receive spasmolytic and enzyme preparations... In important cases, carry out surgical procedures.

Postcholecystectomy syndrome is just one name - dysfunction of the sphinkter Oddi. In the norm, the rhythmic speed of the meat fibers quickly and in small portions enter the intestines, the de-vikon has its own characteristic. When the speed-sensing activity of the sphinkter Odd is impaired, PCES develops.

Zakvoryuvannya MAє code according to ICD-10 K 91.5 and the name "Postcholecystectomy syndrome".

Ethiology

Ethiopathogenetic basis of PCES in an hour before the end of pregnancy. The provincial causal factor of ailment is the dysfunction of the bilious system, which is caused by the damage of the zvichny struma zhovchi.

Factories to produce before the development of PCES:

• Zmіna zhovchі warehouse, skill up to stone processing;
• Hypersecretion of zhovchi by hepatocytes;
• Stagnation of zhovchі in the 12th intestine, accumulation of її zapalennya abo gastroesophageal reflux ailment;
• Spasm of the sphinkter Oddi;
• Common bile duct stricture;
• Intestinal dysbiosis;
• After the cholecystectomy;
• Inappropriate and unprecedented before the operation diagnostics;
• Incomplete obsyag of the operation;
• Іntraoperatsіynі pomachi hirurga;
• Pathological process in the cult duct;
• Spikes in the black empty
• Іnfіkuvannya.

Zahvoryuvannya, scho take out the PHES branch:

1. pancreatitis,
2. firing of small intestinal tracts,
3. reflux esophagitis,
4. diverticulitis;
5. papillitis;
6. the cyst of the zalnoy zhovnoy ducts;
7. fistulas of young gentlemen;
8. intestinal obstruction;
9. fatty liver oil infiltration.

Pislya cholecystectomy function of the chewing mikhura vipadaє. A number of compensatory reactions are switched on. It’s impossible to cope with such mechanisms, the PCES develops.

Pathogenetic Lanka PCES:

• cholecystectomy,
• Development of chronic duodenal failure,
• Hypertension in the 12 intestine,
• Duodenogastric and gastroesophageal reflux,
• Zastiy zhovchi,
• Intestinal bacterial contamination,
• Improving hypertension,
• Asynchronism of the appropriate humus, gut and slurry juice into the intestines,
• Development of secondary pancreatic deficiencies.

symptomatology

Patients with PCES also have symptoms prior to the operation. Клінічні signs pathologies are wide and variable.

1. The main symptom of the ailment is the lingering nature of the rising level of intensity. attack severe pain There can be a total of 20 quills and repeated for 3 months. Regularly from the localization of the won nagaduє bіl at gum ailment, Pancreatitis or at once with both ailments. ill-feeling People are found to be welcomed and often at nights.
2. Dyspeptic syndrome manifests itself as tediousness, bloating, bloating, gurgling in the abdomen, swelling, dryness and girding in the mouth, oven, inappropriate views eating fatty їzhі, diarrhea, the appearance of fat in the feces.
3. Progressively, the ailments develop malabsorption syndrome living talk into the intestines. It is a little too quick to lose weight to the extreme, they develop stomatitis, heylitis and other signs of hypovitaminosis. At the end of the period, you can fix the symptoms of asthenia of the body. Ailments tend to be very weak, sickly, they have a sharp decline in praise, drowsiness, apathy, loss of appetite and interest before they go. Stilts become watery or kashko-like, stinky and even frequent.
4. For some people with ailments, there is a fever, chills, hyperhidrosis, tachycardia.
5. Zhovtyanitsya s pozhovtinnyy shkiri, іn'єktsієyu sclera, shkіrny sverbіnnya.
6. Neurological problems - pain syndrome due to the type of neuralgia of the tripartite nerve, intercostal neuralgia, more at the back.
7. Psycho-social collapse - internal stress, a bit of anxiety and fear, gratitude or emotional lability.

The most clinically asymptomatic variant, in case of any scarg ailments, ale and characteristic changes in the results laboratory dosage blood.

Storage PHES:

• diversion of welders for operations,
• submission of secondary bacterial infections,
• abscess formation of tissue,
• early development of atherosclerosis,
• anemia,
• cachexia,
• deformation of the skeleton,
• avitaminosis,
• іmpotency.

diagnostics

Diagnosis of PCES is to be repaired from hearing ailments of a sick person and taking an anamnesis of sickness. It is necessary to know, after what hour did the cholecystectomy show symptoms? If the operation was carried out?

Fakhivtsi analizuyut family history and know that the slunk-intestinal tract becomes ill.

1. Physical methods of cleaning include the examination and examination of the sick, as well as the palpation of organs of the worm.
2. In zalnoklinіchnі blood analysis - decrease in the number of erythrocytes, hemoglobin, increase in leukocytes and increase in SHOE.
3. Biochemical dosage of blood is the sign of zalny bilirubin, th fraction, ALT, AST, LF, blood glucose, blood amylase.
4. Coprogram - an analysis of feces for the appearance of non-etched fragments of їzhі, fat, coarse grub fibers.
5. Microscopic, bacteriological and biochemical preliminaries are carried out after the show.
6. CT and MRI allow the visualization of judges and organ emptyings.
7. Ultrasonic examination of a cross-cut emptying finds calculi in the gum ducts, burning, expanding and deforming.
8. Prior to advanced methods, radiography of the legends is carried out, as well as to carry out pneumonia and mediastenitis.
9. Radiopaque visibility of the shlunk indicates the appearance of bends.
10. Gastroscopy and FGDS should be performed for the onset of other pathologies of the herbal system.
11. Scintigraphy gives you the ability to reduce the circulation of the woman.
12. Electrocardiography.
13. Transabdominal ultrasonography.
14. Bagatofrakts_yne duodenal probe.
15. Cholegraphy.
16. Sphinkter Oddi manometer.
17. Cholangiopancreatography.

lykuvannya

Lіkuvannya ailments z PHES is complex. Vono is aimed at the weakening of the obvious ruins on the side of the herbal system, as the patient was forced to turn to the lykar. Likuvannya of pathology of polyagus in the pretrimanded suvor's activity, conducted conservative therapy and in case of ineffectiveness - operative involvement.

dietotherapy

We do not need to take care of the feeding regime: take small portions of 5-6 times a day, make up the fat and increase the risk of greasing, sour, hospitality, spice, etc. alcoholic drinks... The ratsion is guilty of being overloaded with vitamins A and B, as well as with grub fibers, cellulose and pectin.

Before permitted products are served compotes, fruit drinks, dried bread, low-fat lactic acid products, vegetable soups, low-fat yalovitch, chicken, roasted cereals, fruit and vegetable salads, greens, beans. Zaboroneni: zdoba, bacon, pork, fatty riba, spices, mint tea and kava, alcoholic beverages, napivnas, smoked meats, pickles.

Video: about the harvesting of food

drug therapy

physiotherapy

By stimulating reparative and regenerative processes, we are sick with PHES, we mean the following physiotherapeutic procedures:

1. Ultrasound on the area of ​​the gum microscope every other day,
2. magnetotherapy,
3. laser therapy,
4. Radon baths.
5. ampl_pulse therapy,
6. Electrophoresis of analgesics and spasmolytics,
7. galvanization,
8. paraphinotherapy,
9. Applikatsii to ozokerite.

Physiotherapy is contraindicated to persons who suffer from cholangitis, liver cirrhosis with ascites, and gastrointestinal dystrophy.

All the ailments are shown the sanatorium-and-spa treatment through the program of operations and regular exercise of exercise therapy.

Folk medicine

Cauti folk medicine, Who polіpshuyut the camp of the ailing people with cholecystectomy:

• nastіy z kіtіv calendula, valerian root, hop cone,
• infusion of centaury, bird gorse, flatbread root, purity, corn rillets,
• vіdvar zvіroboyu, chamomile, Oman,
• zhovchogіnniy zbіr from calendula, m'yat, tansy, chamomile, wood,
• tea from shipshini.

It is worthwhile to lay down the camp during PHES, to learn about the congestion, to avoid the problem, to know the heat. Lіkuvannya folk zasoba guilty takes place in a complex with basic therapy.

accept people zasobi after stretching out a month for a year until after, or in a year, after her. Schob uniknuti zvikannya, so it is necessary to cherguvati.

promptly lykuvannya

The operation should be carried out in quiet vipadk, if conservative methods become ineffective.

Shcheb to sleep a stiff spasm of the sphinkter Oddi, to carry out the developmental manipulations:

1. rosіkayut yogo,
2. inject botulinum toxin,
3. expand the balloon behind the aid,
4. insert the stent,
5. I see rough scars.

prophylaxis

• on the outside and at the right time, the treatment of the sick person before the operation,
• the other day's illnesses are revealed,
• struggle with loud little calls,
• correct eating of fatty foods,
• regular 4-6-fold intake of їzhі,
• zbagachennya ratsion with grub fibers,
• reception of vitamins and minerals,
• normalization of masi tila,
• active way of life,
• overexposure to constipation,
• Regularly cautioned by the gastroenterologist for the operation.

PHES is a pathology, amid the destruction of the etching of functional or organic nature. The symptomatology of the disease is variable and nonspecific. functional breakdown lіkuyut conservatively, and organіchnі - operative.

Video: about the correct rehabilitation of the message

Video: lectures on postholycestectomy syndrome

As a rule, the patients are encouraged to the effectiveness of the recommended surgical operations(Especially planned). However, for those of them, the operatives are not liable to relieve themselves, but new problems, such as to overcome the pre-conservative treatment and therapy. Postcholecistectomy syndrome can be used as a primary butt.

In this statute, we will talk about those for the syndrome, such as its classification, discussing the treatment and recommended children.

What is postcholecystectomy syndrome?

Wise nature has poured over the skin organ of our body with singing functions so that it’s practically visible that any organ doesn’t pass through without any problems. The zhovchny mikhur accumulates in his own way to establish himself in the zhovch's furnace, concentrating it, and also in the zhovchny ducts in the world of need.

Postcholecystectomy syndrome was accepted by nazyvatistan, and there was no evidence of zhivny mikhura (cholecystectomy). Vono sposter approximately at four patients, who have undergone this extended operation. In such ailments, new troublesome scars appear, or they develop symptoms before surgery.

Classification

In the midst of pathologic stanions, which form the essence of postcholecystectomy syndrome, doctors see three groups. Smells are perceived for the type of causal-inherited interconnections in carrying out surgical interventions (cholecystectomy).

Prior to the first group, it is necessary to admit quiet patients with postcholecystectomy syndrome, whose illness is not associated with the operation, and for those other surgeries and do not understand the correct reason for the inadvertence. Tsі ailments simply didn’t pop up immediately diagnosed through:

• inadequate coverage;
• neurological interpretation of scarg and results of diagnostic procedures;
• underestimation of specific pathological conditions, which led to operational problems.

The blame for the development of postcholecystectomy syndrome in ailments from another group is the most surgical treatment of the ugly mikhur. Vono or it was carried out in a lack of communication (for example, in the ducts there were no signs of undetected), as well as in the absence of operational pardons. They can appear:

• trauma to the backbone duct;
• suture granuloma formation;
• pislyaoperats_yny;
• lack of dovga kuksa ducts that in.

Most often, in such cases, the number of operative manipulations is not associated with an obvious pathological process. For example, in case of accelerated gum disease, a surgeon is surrounded by a standard cholecytectomy to replace a greater serious and great involvement.

Basically the formulation of postcholecystectomy syndrome in patients, who are in the third group, are found to be motorized:

• spasm of the sphincter (oocyte valve, scho razdіlyaє zhovchny and pancreatic ducts from the twelve-fingered intestine) Oddі;
• dyskinesia overflowed the gum ducts;
• rukhovi destruction of the twelve-fingered intestine.

symptomatology

Clinically manifest postcholecystectomy syndrome without any cause. Ale nibilsh often wonders if he could accept bully before surgical manipulations:

• pain, localization in the right side of the rib, or in the epicranial dilence, low intensity (as dull to attacks of the classic chewing colic);
• severity or discomfort in the right pidreber;
• schism up to;
• oversized gas supply.

lykuvannya

Likuvalny come, direct to the fight against postcholecystectomy syndrome, are guilty of being complex and individualized (in case of fallowness, cause I will become). The stench can include:

• dietotherapy;
• drug treatment;
• operational methods.

dietotherapy

Navigate in time friendly perebіgu During the operational period, we all have a problem, for the vision of the ruminant is necessary for food. With a stretch of 1.5-2 months the stench is guilty before the children are taken to the table number 5a (behind Pevzner). If the patients are susceptible to diagnosing postcholecystectomy syndrome, then it’s better to go to school # 5.

You can often go to a chemistry warehouse, so as to take away from 90 to 100 g of bottles, the lower quota of fat (50 - 60 g) for those who are included in the list is not just food from refractory fats, ale and rose oil. Obmezhennya roslinnykh fats dotsіlno for weakening zhovchovіlennya. Zm_st in carbohydrates is reduced to 250 - 300 g for cooking sugar and liquorice (for prevention and control and gas formation). Dobova energy efficiency of the given child is not very high (2000 - 2100 kcal). Moreover, in the case of a low carriage, the patients need additional introduction of alcoholic products, or special dietary enteral sums, which are sold in pharmacies (Nutrikon, DISO, Peptamen, SUPREM-760).

Є It is recommended to use skin for 4 years, such a frequency is permissible for a patient who is more likely to refrain from a pickling system, and more in order

The reason for being guilty is that there is no change in products from a high quantity (pork, lamb, fatty dairy products, egg yogurt and in.), So the operation does not change the chemical warehouse. In the meantime, as soon as possible, new stones can be set up (especially in the first time of the surgical engagement). Reshta fat slid growth equitably on all receptions and changes from one another. Tsei zhid can catch the pain and carry it. In order to prevent gas supply, it is necessary to beware of products with coarse cells (fresh vegetables, berries, fruits, hanging and etc.).

Allowed їzha (meat, thermally crushed fruits and vegetables) is guilty of wiping, lean riba can be served with a shmat or in a chopped viglyadі. It is a good idea to recommend vegetable puree, sweet soufflé, grated soups and jelly. Wheat bread is lightly dry. Cold strains, which can provoke spastic processes (spasms) and carry them, become vicious.

It is necessary to remember that, as a result of the operation, the individual portability of the products can be changed. So, there is a negative reaction to sire, cocoa, frosty, chocolate, foodstuffs (pickles and in.), Vegetables with a great amount essential oils(Green tsibulya, radish, chasnik, radish and ін.) In viglyadі vіniknennya pain, diarrhea, abdominal pain.

The triviality of the child's school No. 5ch is started individually (until the most of the views and symptoms of dyspepsia).

If the stagnation of the stagnation of the gum in the left gut ducts is over, the lipotropic-fatty diet No. 5 l / f is justified. Vona is characterized by a higher fat quota (up to 110 g), 50% for a portion of the fat of roselinny walking. At the races, it is necessary to include products with lipotropic power (egg beverages, lean meat, riba, sir), roslinn_ oils and wheat hangings, which are used to dispose of the fat in the body. Allow me to get in, or bother, rub unnecessarily. Oils are added to the ready-made herbs.

Drug treatment

Warehouse and triviality drug therapy to lay down the incidence of symptoms and conditions, to clarify the cause of the postcholecystectomy syndrome. Drug treatment can add up to:

• spasmolytics (No-shpa, Buskopan, Duspatalin and in.)
• prokinetics (Molіlіum, Trіmedat і ін.), which drive motor damage;
• polyenzymes (Panzinorm N, Ermital, Mezim-forte, etc.)
• intestinal antiseptics (Enterofuril, Intetrix i in.), bacteriophages, probiotics (Enterol, Probifor and in.), which fight fermentation dyspepsia.

Hirurgicne involvement

Since the postcholecistectomy syndrome of surgeries with surgical pardons, in a number of cases, it is necessary to re-promptly treat it. You can play a yak in a radical operation with a rosette of black empties and revision internal organs, So, in mensh of serious endoscopic manipulations (for example, in endoscopic sphincterotomy, sphinkter Oddi is used for endoscopic sphincterotomy).