gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2017-27-6-96-108gastro-j-197Research ArticleИНФОРМАЦИЯINFORMATIONРезолюция Экспертного совета «Современный взгляд на проблему постхолецистэктомического синдрома»Postcholecystectomy syndrome: the modern approach: resolution of Advisory councilИвашкинВ. Т.IvashkinV. T.noemail@neicon.ruОхлобыстинА. В.OkhlobystinA. V.pancreat_guidelines@mail.ruБординД. С.BordinD. S.noemail@neicon.ruСелезневаЭ. Я.SeleznyovaE. Ya.noemail@neicon.ruКучерявыйЮ. А.KucheryavyYu. A.noemail@neicon.ruБыстровскаяЕ. В.BystrovskayaYe. V.noemail@neicon.ruВасневО. С.VasnevO. C.noemail@neicon.ruОсипенкоМ. Ф.OsipenkoM. F.noemail@neicon.ruМусаевГ. Х.MusayevG. H.noemail@neicon.ruШульпековаЮ. О.ShulpekovaYu. O.noemail@neicon.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский университет)РоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical UniversityRussian FederationГБУЗ «Московский клинический научный центр им. А.С. Логинова»РоссияState government-financed healthcare institution of the Moscow Health Department «Loginov Moscow Clinical Scientific Center»Russian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им.А.И. Евдокимова»РоссияState educational government-financed institution of higher professional education «Yevdokimov Moscow State University of Medicine and Dentistry»Russian FederationФГБОУ ВО «Новосибирский государственный медицинский университет»РоссияState educational government-financed institution of higher professional education «Novosibirsk state medical university»Russian Federation20171208201827696108Copyright © Ивашкин В.Т., Охлобыстин А.В., Бордин Д.С., Селезнева Э.Я., Кучерявый Ю.А., Быстровская Е.В., Васнев О.С., Осипенко М.Ф., Мусаев Г.Х., Шульпекова Ю.О., 20182018Ивашкин В.Т., Охлобыстин А.В., Бордин Д.С., Селезнева Э.Я., Кучерявый Ю.А., Быстровская Е.В., Васнев О.С., Осипенко М.Ф., Мусаев Г.Х., Шульпекова Ю.О.Ivashkin V.T., Okhlobystin A.V., Bordin D.S., Seleznyova E.Y., Kucheryavy Y.A., Bystrovskaya Y.V., Vasnev O.C., Osipenko M.F., Musayev G.H., Shulpekova Y.O.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/197

Цель публикации. Представить материалы Экспертного совета, который состоялся 25 августа 2017 г. в Праге (Чехия) при поддержке компании «Adamed Group». Основные положения. В ходе работы Экспертного совета был предложен алгоритм обследования и лечения пациентов с постхолецистэктомическим синдромом (ПХЭС). Желчнокаменную болезнь (ЖБК) выявляют у 10-25% населения различного возраста, в настоящее время отмечается четкая тенденция к расширению возрастного диапазона в сторону «омоложения». Количество больных с ЖКБ каждое десятилетие увеличивается как минимум вдвое. Основным методом хирургического лечения ЖКБ, протекающей с клинической симптоматикой, остается холецистэктомия. В последние два десятилетия повсеместное распространение и статус «стандарта» хирургического лечения получила лапароскопическая холецистэктомия. В то же время при бессимптомном течении наиболее целесообразно придерживаться тактики наблюдения за пациентом без активного лечения. Билиарный сладж и микролитиаз, в том числе не диагностированный при рутинном обследовании, могут быть одними из важных факторов развития ПХЭС. Медикаментозная коррекция расстройств функции сфинктера Одди на фоне ЖКБ/ПХЭС должная включать соблюдение диеты, прием селективных спазмолитиков, пищеварительных ферментов, препаратов урсодезоксихолевой кислоты. Выводы. После холецистэктомии показано динамическое наблюдение за пациентами, при появлении/усилении клинической симптоматики - комплексное обследование для исключения хирургического генеза ПХЭС и сопутствующих заболеваний. Лечение должно включать курсовую терапию селективными спазмолитическими препаратами, по показаниям - назначение препаратов желчных кислот, в отдельных случаях - применение методов эндоскопической хирургии.

Aim of publication. To present proceedings of Advisory council on postcholecystectomy syndrome (August 25, 2017; Prague, Czech Republic) with support of the Adamed Group company. Summary. The Advisory council proposed algorithm for investigation and management of patients with postcholecystectomy syndrome (PCS). Gallstone disease (GSD) is diagnosed in 10-25% of the population of various age, with obvious trend to involvement of the younger patient categories in the last decades. The total number of GSD patients increases every decade no less than twice. Cholecystectomy remains the basic method of surgical treatment of symptomatic GSD. Nowadays laparoscopic cholecystectomy became universally popular and earned the status of the «gold standard» of surgical treatment. At the same time at asymptomatic GSD the watchful waiting approach avoiding active treatment is considered to be the most expedient. Biliary sludge and microlithiasis including cases undiagnosed at routine investigation can be one of important factors for development of the PCS. Pharmacological treatment of sphincter of Oddi dysfunction that develop at GSD/PCS include following of dietary recommendations, intake of selective spasmolytics, digestive enzymes and ursodeoxycholic acid. Conclusions. Follow-up program for the patient of the cholecystectomy should include regular assessment of clinical symptoms for duly diagnostics of acute and/or severe complications and associated diseases, that may require surgical treatment. Treatment has to include regular courses of selective antispasmodics, the presence of indications - prescription of bile acid supplements, when required - methods of endoscopic surgery.

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