gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2017-27-2-111-116gastro-j-139Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГОВ, ГЕПАТОЛОГОВNATIONAL COLLEGE OF GASTROENTEROLOGISTS, HEPATOLOGISTSОсобенности патогенеза, диагностики и лечения желчнокаменной болезни при беременностиFeatures of pathogenesis, diagnostics and treatment of gallstone disease at pregnancyУспенскаяЮ. Б.UspenskayaYu. B.jusp@mail.ruШептулинА. А.SheptulinA. A.noemail@neicon.ruФГБОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова»РоссияThe State Education Institution of Higher Professional Training the First Sechenov Moscow State Medical UniversityRussian Federation201712082018272111116Copyright © Успенская Ю.Б., Шептулин А.А., 20182018Успенская Ю.Б., Шептулин А.А.Uspenskaya Y.B., Sheptulin A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/139

Цель работы. Осветить современные представления о патогенезе желчнокаменной болезни (ЖКБ) у беременных и обсудить современные подходы к ее диагностике и лечению. Основные положения. Риск развития билиарного сладжа и холестериновых камней при беременности значительно возрастает, что обусловлено главным образом повышением уровня эстрогенов и прогестерона, приводящим к увеличению выработки холестерина, снижению сократительной функции желчного пузыря и, как следствие, к росту литогенности желчи. Клиническая картина ЖКБ у беременных не отличается от таковой у небеременных женщин. Основное место в диагностике холелитиаза при беременности занимает трансабдоминальное ультразвуковое исследование. В лечении клинически манифестных форм ЖКБ в этот период все большее место занимает активная хирургическая тактика. Методом выбора служит лапароскопическая холецистэктомия, а оптимальными сроками для ее проведения - второй триместр беременности. Для профилактики и лечения билиарного сладжа у беременных возможно применение препаратов урсодезоксихолевой кислоты. Заключение. Повышенный риск возникновения ЖКБ у беременных требует дальнейшего изучения особенностей ведения таких больных, поиска более совершенных методов ее лечения и профилактики.

The aim of review. To highlight the modern concept of the gallstone disease (GSD) pathogenesis at pregnancy and to discuss modern diagnostic and treatment approaches. Summary. The risk of biliary sludge and cholesterol gallstones at pregnancy is significantly increased that is caused mainly due to elevation of estrogen and progesterone level leading to increased cholesterol synthesis, decreased gallbladder contractility and, as a result, to increased lithogenicity of bile. Clinical presentation of GSD at pregnant patients is similar to that at nonpregnant women. Transabdominal ultrasound investigation play the major role in diagnosis of cholelithiasis at pregnancy. For treatment of symptomatic GSD forms in this the period active surgical approach is becoming more and more common. Laparoscopic cholecystectomy is a method of choice, and the optimal term for its implementation is the second trimester of pregnancy. Prevention and treatment of biliary sludge in pregnancy may be carried out by ursodeoxycholic acid. Conclusion. Increased risk of cholelithiasis at pregnant women requires further improvement of management approach and search for better methods for treatment and prophylaxis

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The authors declare that there are no conflicts of interest present.