Management the patients with gallstone disease
Aim. Development of a diagnostic and therapeutic algorithm for optimizing the treatment of gallstone disease based on ultrasound and CT of the gallbladder. Materials and Methods.235 patients (31% of men) were included in the study, mean age (Mediana) = 48 years, mean duration of the disease (Mediana) = 1.8 years. In all cases gallstones have been diagnosed by abdominal ultrasound. Disease risk factors were identified: irregular meals - 78%, heredity - 40%, obesity - 35%; comorbid diseases of the gastrointestinal tract - 75%, heart ischemic disease and arterial hypertension -41%, diabetes mellitus and glucose intolerance-38%, urolithiasis and gout -11%. The technique of Philips CT scanner "MX-8000 IDT-16CT" have been used to evaluate the stones density in Hounsfield Units (X-ray negative stones - < 100 Hounsfield Units). The same method has been used to evaluate steatosis of the liver and pancreas and atherosclerosis of the abdominal part of aorta. Results. All patients were divided into 3 groups: 1) with biliary sludge (bile rheology disorder) -10% (n = 24), 2) with the gallstones density < 100 Hounsfield Units (HU), 41% (n = 98), 3) with the gallstones density > 100 HU - 49% (n = 113). The patients from group 3 were recommended to perform cholecystectomy. Patients with biliary sludge and gallstones <100 HU (N=122), which occupying < 1/3 of the gallbladder volume, were recommended to fol-low hypolipidemic diet, physical activity, body weight normalization, litolytic therapy with ursodeoxicholic acid (UDCA) was administered in daily dose of 10 mg / kg of body weight for 3 months. After the end of this period repeated CT was done. Depending on the result therapy with UDCA was either ended or continued. Steatosis of the liver was detected in 35% of cases (n = 74, Me = 32 units), pancreas - in 32% (n = 70, Me = 28 units). The gallstones density correlated (r = 0.5) with the degree of liver and pancreas steatosis, abdominal aorta atherosclerosis deformation and increased volume of gallbladder, liver cysts and hemangiomas, patients age. After 6 months of UDCA administration biliary sludge resolved in 91.7%, gall-stones with density < 100 HU resolved in 11.3%. After 9 months of such a treatment biliary sludge resolved in 100%, gallstones with density < 100 HU - in 52% of patients. After 12 months, the dissolution of stones reached 81.3%. In 18.7% of cases (n = 18) therapy was unsuccessful. The steatosis of the liver (Me = 55 units) and pancreas (Me = 44 units) decreased according to CT at month 6 and month 12 (p <0.05).Conclusion.Litoliyic therapy with UDCA for 6 months resulted in biliary sludge resolution in 100% cases, the same therapy for 12 months resulted in resolution of gallstones < 100 HU in 82% cases which accompanied with regression of liver and pancreas steatosis. In other conditions cholecystectomy is indicated.