How is cholelithiasis treated?

Non-drug treatment of cholelithiasis

With exacerbation of cholelithiasis, the child must be hospitalized. Assign physiotherapy aimed at improving the outflow of bile: paraffin and ozocerite applications, inductothermy on the liver. It is advisable to use magnesium electrophoresis, 1% papaverine solution, 0.2% solution of platifillin. Useful fresh or coniferous baths with a temperature of 37-37.5 C for 7-12 minutes every other day. The course is 10-12 baths. Spa treatment at the resorts of Zheleznovodsk, Essentuki, Goryachy Klyuch, in local rehabilitation and rehabilitation centers is shown.

Food intake should be regulated; appoint a table number 5. Watching television shows and computer games are limited to 2 hours a day. Physical stress, including sports, is limited not to provoke abdominal pain, however, the complete exclusion of exercise and outdoor exercise is unacceptable because of the risk of developing a hypokinetic syndrome.

Drug treatment of cholelithiasis

Apply preparations of bile acids - derivatives of deoxycholic acid. In childhood, only ursodeoxycholic acid is used, children up to 3 years of age are prescribed as a syrup, children older than 4 years in capsules, inside 10 mg Dkgsut). The whole dose should be taken in the evening before going to bed, washed down with liquid (water, tea, juices, milk, etc.). Ursodeoxycholic acid has good tolerability, has no side effects. Duration of treatment is from 6 to 24 months continuous course.

With long-term drug litholysis of gallstones, hepatoprotectors of combined action-hepabenum-are prescribed. Hofitol. Choosing a drug, focus on the functional state of the biliary tract. In hypertensive dysfunction, hepabene is used (1 capsule with meals 3 times a day, 1 capsule at bedtime for 1-3 months), which has an antispasmodic effect. When hypotension of the gallbladder is prescribed hofitol inside 1 tablet at the age of 5-10 years or 2 tablets in 15 years 3 times a day before meals for 2 weeks.

Contraindications to the appointment of conservative treatment:

• complicated course of cholelithiasis (acute and chronic cholecystitis, biliary colic and other diseases);
• disconnected gallbladder;
• obesity of the third degree;
• chronic hepatitis and cirrhosis;
• chronic diarrhea:
• single concrements more than 15 mm in diameter, multiple, occupying more than 50% of the gallbladder lumen;
• pregnancy;
• gallbladder carcinoma;
• choledocholithiasis.

In case of severe gallstones, litholytic treatment is indicated in cases when the probability of an adverse outcome of an operative intervention is higher than the risk of a lethal outcome of cholelithiasis, for example, in children with congenital heart defects, hemolytic anemia and other severe physical illnesses.

Before the treatment of the parents and the child itself should be informed about the duration of treatment, ranging from 6 months to 2 years, and the frequency of recurrence of stone formation after the end of treatment.

The therapeutic effect and side effects of the drugs used are controlled in the first 3 months every 4 weeks, by examining the activity of blood enzymes, and then performing ultrasound of the bile ducts every 6 months.

In the treatment of ursodeoxycholic acid, diarrhea rarely disappears on its own on the 4th-5th day of treatment or after a decrease in the dose of drugs. A subsequent increase in dose does not lead to the resumption of diarrhea.

Even careful selection of patients with indications for litholytic treatment and proper selection of medications allows to achieve success only in 22-25% of cases in children with cholelithiasis at the stage of formation of gallstones. In 68% of children at the stage of biliary sludge treatment does not prevent relapses of stone formation, sediment formation, biliary colic attacks and complications.

Surgical treatment of cholelithiasis

The alternative to the conservative method is laparoscopic cholecystectomy. Indications for surgical intervention are determined by considering the following factors:

• the child's age;
• the size and location of gallstones;
• duration of the disease;
• clinical form of cholelithiasis (asymptomatic calcification, painful form, biliary colic).

Children under 3 years of age are recommended to follow the pediatrician and surgeon, according to the indications, they are prescribed litholytic therapy, with relapsing abdominal pain - surgical treatment. At this age, spontaneous dissolution of gallstones is possible.

At the age of 3 to 12 years, planned surgery is indicated for children with dyspeptic form of cholelithiasis and biliary colic. The performance of cholecystectomy at this age is pathogenetically justified, since removal of the shock organ does not lead to a disruption of the functional capacity of the liver and biliary tract. Formation of postcholecystectomy syndrome does not occur.

Children of 12-15 years of age should undergo surgical interventions only for emergency indications. Operation, anesthesia in the period of imbalance of neuroendocrinal functions can trigger hereditary chronic diseases; possibly rapid (within 1-2 months) the formation of alimentary-constitutional obesity, arterial hypertension, interstitial nephritis.

Forecast

In cases of early diagnosis and adequate treatment, the prognosis is favorable.

[1], [2], [3], [4], [5]