mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2022-12-21mossj-611Research ArticleСтатьиПациенты с бессимптомным течением желчнокаменной болезни, оценка факторов риска осложнений и выбор групп пациентов для хирургического леченияPatients with asymptomatic course of cholelithiasis, assessment of risk factors for complications and selection of patient groups for surgical treatmentАгафоновИ. Н.AgafonovI. N.

Агафонов Игорь Николаевич – к. м. н., врач-хирург

109431, Москва, ул. Авиаконструктора Миля, д.6, стр.1

Agafonov Igor Nikolaevich – Ph.D., surgeon

109431, Moscow, Aviakonstruktora Mil str., 6, p. 1

Agafonoff8@mail.ruГосударственное бюджетное учреждение здравоохранения «Городская поликлиника № 23 Департамента здравоохранения города Москвы»РоссияState Budgetary Healthcare Institution "City Polyclinic № 23 of the Moscow City Health Department"Russian Federation20220401202305Специальный выпуск1221Copyright © Агафонов И.Н., 20232023Агафонов И.Н.Agafonov I.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/611

В статье рассматривается обзор литературы о лечении пациентов с бессимптомным течением желчнокаменной болезни. Желчнокаменная болезнь распространена у 10–13 % населения, но лишь у 13–22 % развиваются симптомы болезни и осложнения. Статья показывает,  как менялись взгляды на проблему лечения желчнокаменной болезни по мере появления новых технологий, таких как ультразвуковое  исследование брюшной полости, которое позволило выявить значительное количество пациентов с желчнокаменной болезнью. Введение  лапароскопической холецистэктомии значительно облегчило для пациента хирургическое лечение и дало возможность расширить  показания для холецистэктомии.

На данный момент существуют различные точки зрения на необходимость хирургического лечения желчнокаменной болезни. Существует точка  зрения, что единственным методом лечения больных с желчнокаменной болезнью является холецистэктомия. Однако большинство авторов  считают, что при бессимптомной желчнокаменной болезни более оправдана выжидательная тактика и даже распространяют эту тактику на  пациентов с перенесенным эпизодом холецистита.

Сама группа бессимптомных пациентов неоднородна. Некоторые пациенты с желчнокаменной болезнью, не имеющие острых приступов, могут  иметь симптомы диспепсии. Хирургическое лечение может улучшить состояние данных пациентов.

Среди бессимптомных пациентов с желчнокаменной болезнью есть следующие группы пациентов с высоким риском осложнений, которым  хирургическое лечение оправдано: фарфоровый желчный пузырь, макролитиаз, отключенный желчный пузырь, гемолитическая анемия. Также  обсуждается необходимость холецистэктомии у пациентов с камнями в желчном пузыре, которым проводится операция на органах брюшной  полости по другому заболеванию.

Разделение пациентов с бессимптомной желчнокаменной болезнью на тех, кому предпочтительно хирургическое лечение и тех, кому достаточно  наблюдение, позволит уменьшить число осложнений желчнокаменой болезни и снизить нагрузку на здравоохранение. Для определения тактики  лечения некоторых групп пациентов необходимы дальнейшие клинические исследования.

The article reviews works on the treatment of patients with asymptomatic cholelithiasis. Cholelithiasis is common in 10-13% of the population, but only 13-22% develop symptoms of the disease and complications. The article examines how views on the problem of treatment of cholelithiasis have been changing with the introduction of new technologies: ultrasound examination of the abdominal cavity, which made it possible to identify a significant number of patients with cholelithiasis. The introduction of laparoscopic cholecystectomy significantly facilitated surgical treatment for the patient and allowed to expand the indications for cholecystectomy.

At the moment, there are different points of view on the need for surgical treatment of cholelithiasis. Some consider that cholecystomy is the only method of treating patients with cholelithiasis. However, most authors believe that in asymptomatic cholelithiasis, a wait-and-see tactic is more justified, and even extend this tactic to patients with a previous episode of cholecystitis.

Among asymptomatic patients with cholelithiasis, there are groups of patients with a high risk of complications for whom surgical treatment is justified: Porcelain gallbladder, macro- and micro-lithiasis, multiple gallstones, disconnected gallbladder, hemolytic anemia. Besides, the necessity of cholecystectomy in patients with gallstones undergoing surgery on abdominal organs for another disease is also being discussed.

Dividing patients with asymptomatic cholelithiasis into those for whom surgical treatment is preferable and those who are sufficiently monitored will reduce the number of complications of cholelithiasis and reduce the burden on Healthcare. However further clinical studies are needed to determine the treatment tactics for some groups of patients.

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