Disbacteriosis of different stage is developed among the most patients after cholecystectomy. It requires a correction with prebiotics, probiotics, and synbiotcs. Implementation of an improved scheme of complex conservative treatment allows us to arrest clinic displays of disbaceriosis among patients with postholecystectomic syndrome in a shorter time frame.

Introduction

Cholelithiasis (CLS) is reasonably considered one of the most widespread diseases and it is only overcome by atherosclerosis, leaving ulcerous disease of stomach and duodenum bowel behind [4, 5, 8, 9].

About 3 million surgeries take place on ulcerous tracts every year, the majority of them are cholecystectomies [3].

However, cholecystectomy on CLS does not always solve problems of a patient. Among most of them pain syndrome and dispersion stay unchanged and are generalized by the term postcholecystectomic syndrome (PCHS) [2,6].

In pathogenesis of CLS and PCHS a significant part belongs to microflora of bowel and hepatobiliary area. However, the results of bacteriologic research of gall are not always similar with this pathology. The results of defining perceptibility of bilicultures are contradictory, as well as the data on development of disbacteriosis in different periods after cholecystectomia [1, 7].

The research objective: improving results of treating patients with disbacteriosis after cholecystectomia.

Research methods and materials

Totally 89 patients of age 25 to 80 years of both sexes with postcholecystectomic syndrome (PCHS) were studied.

The research included 69 (77,6%) women and 20 (22,4%) men.

The patients were divided into 2 groups:

Group 1 - patients with PCHS of functional nature (36 patients) who received traditional conservative therapy.

Group 2 - patients with PCHS of functional nature (53 patients) who received complex therapy of an improved scheme.

The patients were investigated for anamnestic data, presence of attendant pathology, physical study was carried out, as well as clinic analysis of blood and urine, instrumental methods of investigating abdominal cavity and extraperitoneal area (ultrasound scanning), fiberoptic esophagogastroduodenoscopy with studying mouth of big duodenal papilla, radiography of chest, electric cardiography.

Investigation of defecation for disbacteriosis was carried out before the anti-bacterisl therapy among the patients.

Patients of the 1st group received traditional conservative treatments that diet included limitations, intravenous infusions of glucose-novocaine mixtures, salt solutions, Н2-histamine-antagonists (Quamatel), intravenous injections of myotropic spasmolytic preparations According to recommendations empiric anti-microbal chemical therapy with preparations of penicilline group or amino glycosides was prescribed.

Patients of group 2 were treated with a complex conservative therapy of an improved scheme that is displayed in table 1.

table 1.

An improved scheme of complex conservative therapy

that was used for patients of group 2

Duration of keeping in hospital equaled 8,7±0,09 bed-days for patients of group 1, 6,3±0,1 bed-days for patients of group 2.

The investigation of defecations for disbacteriosis was carried out according to requirement of the Order of Ministry of healthcare of USSR №535 of 22.04.1985 and recommendations of the Worldwide organization of healthcare, investigation of defecations for disbacteriosis was carried out according to the Order of Ministry of healthcare of RF №231 on setting a branch standard "Protocol of treating patients. Disbacteriosis of bowel" of 09.06.2003.

Statistic processing of the received data was carried out with the application «Microsoft Excel». The results are provided in an average value with an average square error (M±m). While the data corresponds to the law normal distribution and number of values of more than 30 units, reliability of differences was analyzed with t-criterion of Student-Fisher. In small selections (number of observations less than 30) reliability of differences was estimated with the non-parametric criterion of Wilkinson (T) for related selections and criterion of Wilkinson-Mann-Witney (U) for unrelated selections. Angle criterion of Fisher (φ) was used to compare selections on frequency of a phenomenon. Pair correlation analysis according to Pirson was used to study correlations between the studied parameters.

Results and discussions

Signs of disbacteriosis, expressed differently, were revealed among all patients of groups 1 and 2. While studying 34 defecation probes in 1-12 months after cholecystectomy, it has been established that contents of bowel microflora altered for all studied patients (table 2).

Table 2.

Quantitative and qualitative content of bowel microflora

among patients after cholecystectomy

* - Klebsiella spp., Enterobacter spp., Hafnia spp., Serratia spp., Proteus spp., Morganella spp., Providencia spp., Citrobacter spp. etc.

** - Pseudomonas spp., Acinetobacter spp. etc.

Disbacteriosis of the third stage was found among 6 patients (17,6%), the second - among 19 patients (55,8%), the first stage - among 8 patients (23,5%), and only one patient showed no signs of disbacteriosis.

Thus removing gull bladder led to alterations in qualitative and quantitative contents of bowel normoflora for almost all patients. This fact goes along with dyspeptic phenomenons. Expressed disturbances are also observed during the first months after cholecystectomy, so it requires correction with pre-, pro-, and synbiotics.

Initially, patients of group 1 expressed complains stomachaches of bilinear - 25(69,4%) or pancreatic nature 11(30,6%), nausea - 31(86,1%), mouth dryness - 28(77,7%), vomiting gull - 24(66,6%), diarrhea - 17(47,2%), or constipation - 13(36,1%). We have registered increase in amylase (over 8,1 mg/s×l) in 21 case (58,3%), GPT, GOT (1,36 - 2,04 mmole/h×l) - in 25 cases (69,4%).

Patients of group 2 expressed complains stomachaches of bilinear - 32(60,4%) or pancreatic nature 21(39,6%), nausea - 50(94,3%), mouth dryness - 47(88,7%), vomiting gull - 36(67,9%), diarrhea - 29(54,7%) or constipation - 17(32%). We have registered increase in amylase (over 8,1 mg/s×l) in 28 cases (52,8%), GPT, GOT (1,36 - 2,04 mmole/h×l) - in 35 cases (66%).

As you can see in table 3, removal of pain syndrome and dispersion was registered among patients of group 2 as well as normalization of biochemical blood indexes in earlier terms, compared to patients of group1.

Table 3.

Dynamics of symptoms and laboratory indications in groups 1 and 2 against treatment

* - p < 0,05 (while F>1,64);

** - p < 0,01 (while F>2,31)

Thus, implementation of the suggested improves scheme of complex conservative treatment allowed us to reduce pain syndrome among patients of group 2, reduce nausea, normalize stool under diarrhea and constipation, normalization of aminotransferase level took place on day 9 in majority of cases.

Resume:

1. A necessary correction with prebiotics, probiotics, and synbiotics is required for disbacteriosis that develops among 97% of patients after cholecystectomy.

2. The developed scheme of complex therapy allows us to reduce signs of postcholecystomic syndrome of functional etiology and disbacteriosis in earlier terms in comparison with traditional conservative treatment.

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