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 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.