Removal of polyps in the gallbladder with a laser. Removal of gallbladder polyps without surgery

21.10.2019 -

Polyp - benign neoplasm, which is a consequence of hyperplasia of the mucous membranes.

They can affect various internal organs, including the gallbladder. Is such a diagnosis dangerous, and what to do in such a situation?

Often polyps in the gallbladder are detected in women older than 35 years. They can also appear in men, but in this case their character will be somewhat different. For women, hyperplastic polyps are most characteristic, for men - cholesterol ones.

What it is?

Polyps are growths of the superficial mucous membrane of the gallbladder, which can be single or multiple. Such neoplasms can reach quite large sizes(1-2 cm), or to form nets of small growths 1-2 mm high.

Despite the benign nature of polyps, if left untreated, they can become malignant. As a result, the patient may develop gallbladder cancer.

Classification

Polyps in the gallbladder can be represented by:

Cholesterol polyps are the most common and respond best to conservative treatment.

Causes

By filtering the blood, a continuous process of bile formation occurs in the liver tissues. Through the bile ducts, it enters the gallbladder, where a yellow-brown liquid accumulates. When food reaches the duodenum, the gallbladder contracts and releases bile, which aids in digestion and the breakdown of food.

With the development of pathological processes, the gallbladder decreases in volume, simultaneously losing the function of bile concentration. As a result, the fluid begins to stagnate, which provokes the appearance of mucous neoplasms.

The reasons for the formation of one or several polyps at once lie in the violation of metabolic processes and anomalies in the structure of the mucous membrane of the gallbladder. Blood relatives of a patient with polyps are automatically at risk.

Polyps in the gallbladder are most susceptible to persons with:

pathologies of the endocrine system;
disturbed fat metabolism;
hypercholesterolemia caused by the abuse of junk food;
hepatitis;
urolithiasis;

In some cases, the formation of polyps can occur after suffering infectious diseases.

Symptoms of polyps in the gallbladder

The symptoms of the pathological process depend on the area in which the polyps formed. The most unfavorable is the case when polyposis growths are localized on the neck of the gallbladder or in its ducts. Such an anomaly creates a serious barrier to the movement of bile into the intestines, which is why the patient may develop such a dangerous and unpleasant pathology as obstructive jaundice.

If the location of the polyps are other parts of the gallbladder, then no specific clinical picture does not occur. However, it is still possible to suspect the disease. To do this, pay attention to the presence of the following signs:

Pain in the right hypochondrium, which occur due to stretching of the walls of the gallbladder due to stagnation of bile. The pains are dull, aching in nature. They occur periodically, they are given to the right hypochondrium, so patients often complain that they have a "liver hurts". Pain syndrome can occur against the background of the use of alcohol or fatty, fried foods. For this reason, most patients are unaware of the presence of polyps, associating malaise with stress or malnutrition.
Yellowing of the epidermis and mucous membranes of the eyes, oral cavity and etc. In the presence of a polyp in the bile duct, obstructive jaundice develops, accompanied by the above abnormalities. Blocked bile duct prevents bile from getting out naturally, therefore seeps through the walls of the bladder and enters the bloodstream. The patient is suffering from skin itching, bouts of nausea, vomiting of bile masses may open. A characteristic sign of obstructive jaundice is the darkening of urine.
Hepatic colic. If the neoplasm has a long stalk and is localized in the neck of the gallbladder, then when it is twisted, an attack of hepatic colic develops. Often this symptom occurs with a significant reduction in the diseased organ. If there is a torsion of the polyposis leg, the patient has a sharp attack of acute, cramping pain. He is tormented by symptoms of arterial hypertension and heart palpitations. At the same time, anxiety symptoms do not disappear when a person takes a comfortable posture, which indicates the development of hepatic colic.
Signs of dyspepsia. It is by its presence that one can judge polyps in the gallbladder. The degree of its severity may vary in each individual case. Typical manifestations of dyspeptic symptoms are bitterness in the mouth, bouts of nausea in the morning, the occurrence of vomiting when overeating. All these anomalies are the result of stagnant processes in the body. It also adversely affects digestion, which can lead to dramatic weight loss.

Despite this, patients rarely present with such symptoms for medical assistance. But timely ultrasound helps to identify the polyp and determine its exact location.

What is the danger of a gallbladder polyp?

Polyps in the gallbladder are dangerous in terms of their ability to degenerate into a cancerous tumor. This probability ranges from 10-30%.

In addition, polyposis formations can cause suppuration in the diseased organ. Against the background of an increased level of bilirubin, brain intoxication may develop. Avoid these dangerous complications possible only if you seek qualified medical help in a timely manner.

Diagnostics

The presence of polyps can be determined during an ultrasound diagnosis of the liver and gallbladder. On the monitor of the ultrasound machine, the specialist can clearly see the formation of a rounded shape, which is attached to the wall of the gallbladder and does not have an acoustic shadow.

To date, one of the most informative diagnostic methods is endoscopic ultrasonography. The procedure is carried out according to the principle of FGDS. A flexible endoscopic tube with an ultrasonic sensor at the end is inserted into the patient's duodenum. Since the duodenum is located in close proximity to the gallbladder, the picture during ultrasonography is much clearer.

Surgery

Surgery is the only effective way to treat polyps. However, it will not be possible to cope with the pathological process by removing only growths - it is necessary to remove the entire organ.

There are situations when surgery cannot be postponed. These include:

the size of the polyp is 1 cm or more;
parallel course in the gallbladder of other pathological processes: cholelithiasis or cholecystitis, which has passed into the phase of chronicity;
rapid growth of build-up;
the abundance of polyps;
high risk of malignancy.

Laparoscopic cholecystectomy

In this case, the removal of the gallbladder is performed using endoscopic medical equipment. When carrying out manipulations on the anterior abdominal wall, several punctures are made through which abdominal cavity introduce special instruments - trocars. They are equipped with hollow tubes with valve devices at the ends. They are necessary for the safe separation of tissues. Only after placing the trocars, a laparoscope and a special eyepiece with a video camera are inserted into the punctures.

Before the operation, the patient undergoes repeated ultrasound diagnostics, CBC and a coagulogram. The procedure is carried out in several stages:

The doctor makes 4 incisions, after which he inserts trocars.
Working medical instruments are placed into the abdominal cavity through trocars.
A preliminary examination of the peritoneal organs is carried out.
The hepatoduodenal ligament is identified with the cystic artery and duct, which are then clipped (a procedure in which the artery and duct are ligated and crossed).
With the help of an electrocoagulator, the doctor separates the gallbladder and excised it.
Through the punctures made, the gallbladder is carefully removed from the abdominal cavity.

The advantages of laparoscopic cholecystectomy include:

minor and short-term pain during the rehabilitation period;
lack of prolonged stay in the hospital (as a rule, the patient is hospitalized for no more than 5 days);
low risk of complications (formation of adhesions, attachment bacterial infection and etc.);
the patient's ability to independently serve themselves after the procedure.

Open cholecystectomy

In this case, not punctures, but incisions are made in the patient's abdominal cavity. Manipulation is carried out through laparotomy - cutting the abdominal wall to gain access to the diseased organ. With polyps in the gallbladder, as a rule, an oblique laparotomy is performed. To gain access to the liver and gallbladder, an oblique incision is made along the edge of the costal arch.

The operation is carried out in stages:

The place where the preliminary incision was made is treated with antiseptic preparations.
An incision of 10-15 cm is made with a scalpel.
Fabrics are cut in layers.
As with laparoscopic cholecystectomy, the doctor locates the hepatoduodenal ligament and clips the artery and duct.
The gallbladder is separated from the liver bed and ligated, after which it is excised.
Together with the organs, resection of regional lymph nodes is performed.
The tissues in the incision area are sutured layer by layer, but in reverse order.

Laparotomic cholecystectomy is performed if the polyps have reached sizes from 15 to 18 mm. Doctors say that such polyposis growths are prone to malignancy, therefore, during surgery, the removal of the bladder along with regional lymph nodes is required. In parallel, a small piece of liver tissue is excised for examination under a microscope.

Open cholecystectomy is performed exclusively under general anesthesia, and only with the use of a ventilator. Postoperative sutures removed for 6-7 days. On the first day after the intervention, the patient is only allowed to drink non-carbonated water, the next day - to eat in limited quantities. You can get up after the operation for 3-4 days. The duration of the rehabilitation period is about 14 days.

Nutrition rules

To avoid stagnation of bile and disruption of the digestive tract, you must adhere to a strict diet. Table number 5 involves the following activities:

fractional meals (4-5 times a day at regular intervals);
eating only easily digestible food (liquid, "broken" on a blender or grated through a sieve);
complete rejection of confectionery and bakery products, muffins;
the use of unsaturated and non-acidic juices, fruit drinks, herbal decoctions, herbal teas;
complete exclusion of products containing caffeine and ethyl alcohol;
refusal of carbonated drinks;
drinking up to 2 liters of fluid per day;
the use of semi-hard fat-free cheese, vegetable puree soups, boiled or oven-baked vegetables and fruits.

You can include a small amount of sweets and cookies in the diet. At the same time, it is necessary to control the level of consumed fats, protein and carbohydrates.

Such a diet is designed for six months, but sometimes it has to be followed for longer. During its duration, the patient is forbidden to drink alcohol and smoke.

Forecast

If the polyps in the gallbladder are small and not prone to growth, then the prognosis for their treatment is considered favorable. It is possible to stop the symptoms and reduce the risk of the spread of the pathological process by periodically conducting courses of conservative therapy.

However, the complexity of the situation lies in the fact that initial stages development of the disease does not manifest itself. Consequently, the symptoms appear already when the polyposis growths reach large sizes. And this is already fraught with their degeneration into malignant neoplasms.

To avoid such consequences, you do not need to wait for the symptoms to go away on their own. You should immediately consult a doctor and undergo an examination. The earlier the disease is detected, the more favorable the outcome of treatment will be.

Bladder dysfunction is a common phenomenon, diagnosed mainly in adulthood and old age. If structures uncharacteristic for a healthy state appear in the cavity, they disrupt the work of not only the bile, but also the systems adjacent to it. The nature of the changes depends on the form of polyposis, which is diagnosed in a particular case.

The gallbladder plays an important role in the functioning of the digestive tract. The secret produced by the body is necessary for correct processing incoming products. If the wall structure changes, a significant failure occurs. One of the reasons for a possible violation is the formation of pathological formations. It is possible to recognize the disease by a number of characteristic symptoms.

What is a polyp

For research on suspicion of a tumor or papilloma of the gallbladder, doctors plan a set of tests and procedures:

ultrasound. The purpose of the manipulation is to determine the number of polyps, their localization.
Ultrasonography is the study of the structure of the gall and duodenum by introducing a flexible endoscope with an ultrasonic sensor into the gastrointestinal tract. In addition to the examination, as part of the procedure, a tissue sample is taken for histology.
Magnetic resonance cholangiography. With the help of the examination, it is possible to visualize the polyp of the gallbladder bubble and get information about its size, the presence of accompanying structures. If any arose as a result of the development of cancer.
Multislice computed tomography. It is prescribed when it is required to assess the amount of a contrast agent.

In addition to diagnosing the gallbladder itself, the list of activities also includes the following tests:

Biochemistry of blood. Polyposis confirms elevated levels of bilirubin, alkaline phosphatase, cholesterol.
General analysis urine. The diagnosis is made when a low content of urobilinogen is detected.
Coprogram for determining the level of stercobilin. In a pathological condition, it is absent or detected in a minimal amount.

A thorough differential diagnosis is also carried out due to the similarity of the symptoms of the disease with other pathologies of the gastrointestinal tract.

How to treat polyps in the gallbladder

Therapy for this disease depends on the type of growths detected. According to statistics, a significant part of the structures is of a cholesterol nature. Such loose formations with a height of not more than 10 mm can dissolve themselves under the action of bile. To speed up the process, they plan to take medication to stimulate the release of physiological secretion and improve its quality. Additionally, a diet is prescribed. The duration of the course is at least 3 months.

Used medicines

good effect gives use the following drugs:

Simvastatin - helps cleanse the blood of cholesterol and lipoproteins.
Ursofalk - activates the destruction of deposits containing unacceptable fractions.
Holiver - necessary to enhance the production of bile. Helps to treat polyposis due to the elimination of congestion.
Ursosan - starts the mechanism of dissolution of cholesterol stones, if the gallbladder retains its function.
No-shpa, Gepabene - aids to relax the smooth muscles of the bladder, expand the ducts.
Allohol - to increase secretory function liver cells, stimulation of bile acid synthesis, weakening inflammatory process.

vitamins

They are included in the drug regimen to speed up recovery. The following vitamin complex becomes important for the body:

Group B (B2, B6, B9, B12) - normalizes metabolic processes, supplying cells with oxygen, contributes to the stabilization nervous system, strengthening immunity, increasing hemoglobin.
Rutin - to protect the vascular walls, eliminate tissue swelling and activate blood circulation.
Ascorbic acid - helps to rid the body of toxins and is involved in regenerative processes.

It is desirable that cocarboxylase be present in the scheme, a sufficient level of which is needed for protein-carbohydrate metabolism. Vitamins can be administered by taking capsules or by injection.

Folk remedies

It is also possible to treat polyposis with natural compounds. if they are considered as an addition to the main therapy. The following recipes are recommended:

A tablespoon of dry chopped celandine is brewed in a thermos with a glass of boiling water and left to infuse for 2 hours. In a filtered and cooled form, the remedy is drunk three times a day in a tablespoon. Eating is allowed in half an hour. Therapy is carried out in courses with a month of admission and a ten-day break.
Mixed in equal proportions, celandine and chamomile are poured into 200 ml of only boiled water and left for 6 hours. A single dose - a tablespoon - is drunk 30 minutes before the main meal.
Juice or infusion of celandine in the amount of 5 ml is used for enemas. A total of 15 procedures are required, then a two-week break is taken. At the end of the rest, the dose of the main drug is increased to 15 ml and a course of the same duration is carried out. The third method involves the use of 3 tablespoons of juice or infusion in one approach.
Mushrooms-raincoats in the amount of 15 pieces, without prior washing, pour 100 ml of vodka and insist for a week in a dark place, stirring the liquid daily. At the end of the specified period, the dense mass is squeezed out, crushed, 500 g of butter, 3 tablespoons of honey are added. The optimal storage conditions for the finished composition is a refrigerator. Treatment of polyps is carried out by taking half an hour after eating 15 g of the drug.

The bee product is regarded as an effective cure for polyposis. It is allowed to eat it in its pure form on an empty stomach or prepare mixtures with calendula, olive oil, aloe. To obtain the desired effect, the drug is drunk two minutes before meals.

Physiotherapy treatment

It is not allowed to carry out therapy if chronic cholecystitis is diagnosed in acute phase, nodes are present in the biliary system or polyposis is distributed over a large area. In other situations, follow these recommendations:

Optimal methods - exercise therapy, massage.
Thermal procedures using ozocerite and paraffin are unacceptable when an operation is planned or performed.
If the gallbladder is removed, doctors are already on early dates prescribe subsequent mud treatment with the use of silt, peat, sulfide, sapropelic mass.

Exercises for polyps of the gallbladder

With polyposis, physiotherapy exercises are indicated. A special complex helps to normalize the work of the biliary system, eliminate unpleasant symptoms. In this case, regularity is important, only then you can count on positive changes.

Lying on your back, legs bent at the knees are wrapped around your arms and pulled to your chest. In this position, rolls to the sides and forward, backward.
They proceed to alternate bending of the legs in the knee joints with their rise to the level chest.
Keeping the supine position, draw in and relax the stomach as much as possible. The number of repetitions is from 5 to 10.
Standing, spread your legs shoulder-width apart and begin to rotate the upper half of the body to the left and right.

If possible, gymnastics is supplemented with breathing exercises, yoga for beginners. As for the rest physical activity, they are limited, sharp movements, weight lifting are excluded.

Removal operation

Cholesterol polyps and formations of a different nature are surgically removed only in the most extreme case, when it is not possible to preserve the integrity of the organ.

Indications

The operation is prescribed in such situations:

Rapid growth of tumors, if their size increases by 2 mm per year.
The initial diameter of neoplasms is from 1 cm or more.
The presence of numerous growths that do not have legs, but have a wide base.

Intervention can be carried out only after a series of preliminary measures.

Training

The list of necessary procedures includes the following:

Ultrasound of the gallbladder, liver, pancreas. The purpose of diagnostics is to identify concomitant pathologies, inflammatory processes, count the number of polyps, determine their type and size.
CT or MRI of the digestive tract to assess the condition of the mucosa, study tissues for cicatricial, adhesive changes, thickenings, nodes.
Analysis of bile for counting epithelial, blood cells, detection of calcium bilirubinate, cholesterol. Additionally, a test for Giardia is carried out.
Respiratory and of cardio-vascular system by ECG, X-ray.

Polypectomy is the least traumatic intervention., when digestive organ released from the formed growths. In more serious situations, you have to remove the bladder. Immediately before carrying out such an operation, a number of recommendations are made:

Eliminate the use of products that thin the blood and disrupt clotting, as well as drugs to minimize the risk of bleeding.
The night before, the intestines are cleansed by taking a laxative or administering an enema.
On the appointed day, refuse any liquid and food.

After operation

If the gallbladder is removed, the diet is completely revised. This need is due to the insufficient concentration of physiological substances for the digestion of food. At the same time, the activity of enzymes decreases. The period of full adaptation to the new state is about 2 years.

Appropriate advice is:

Eat boiled or steamed foods.
Food is sent to the mouth in small pieces and chewed thoroughly.
A single portion should be minimal, the number of meals is growing.

Six months later, they begin to introduce fresh fruits and vegetables, lean meat, and fish into the diet. The restriction for another year is imposed on sour, spicy dishes and products, as well as food rich in essential oils. Return to the usual table is possible after 24 months.

As for physical activity, only half-hour walks are recommended in the postoperative period, swimming is allowed after 6 months, morning exercises without stress on the abdominal muscles.

Do they take to the army with a pathology

Due to the severe limitation of physical activity and dietary advice in the army with such a disease in the presence of a confirmed diagnosis is not taken. A decisive role is played by the examination appointed by the military registration and enlistment office.

Predicted Complications

A positive prognosis for polyposis is possible if it is possible to diagnose on time and limit ourselves to conservative treatment without radical intervention. When neoplasms are actively growing, negative scenarios are not excluded:

Spasms of the duct and severe dyskinesia. The consequence of the chronic course of such a process is cholelithiasis (abbreviated cholelithiasis), cholecystitis requiring surgery, dysfunction of the sphincter responsible for delimiting the duodenum and biliary tract.
Pancreatitis in acute form. We are talking about the inflammatory process against the background of spasm or infection of the bladder.
The degeneration of a polyp into a cancerous tumor, torsion and death of the growth, overlapping of the duct cavity with an overgrown formation.

Dangerous are multiple polyposis structures that can fill the entire space of the gallbladder. Such tumors can disappear on their own, but such a solution to the problem is extremely rare and only in the case of small pedunculated polyps. The wide base of the pathogenic formation indicates a high chance of its degeneration into a malignant structure.

Polyps are growths of the surface epithelium of the gallbladder, can be single and large 1-2 cm, or form a network of small neoplasms 1-2 mm high. Polyps are benign in nature, but if they are present, the risk of oncological cell degeneration and development increases.

The following figures reflect important information about polyposis and organ cancer:

Oncological diseases of the gallbladder are rare and range from 0.27 to 0.41% of all cancers.

Gallbladder cancer is twice as common among women as among male patients.

The risk of oncology increases with age, increases from the age of 45, and reaches its peak at 56-70 years.

Biliary tract operations can provoke the development of gallbladder cancer - it develops in 1-5% of all cases.

Among the others oncological diseases digestive tract cancer of the gallbladder is in fifth place after diseases such as cancer of the pancreas, stomach, intestines (rectum and colon)

Symptoms of polyps in the gallbladder

Any manifestations of the disease will depend on where it is located. The most unfavorable situation is its growth on the neck of the bladder, or inside its duct. This creates a barrier to the path of bile into the intestines, which causes the patient to develop a disease such as obstructive jaundice. When polyposis growths are localized in other parts of the gallbladder, the patient does not experience any specific symptoms.

However, it is possible to suspect its presence in the body for some indirect signs:

Pain. They appear in response to excessive stretching of the walls of the organ not by the polyp itself, but by bile, which stagnates through its fault. Such stagnant processes lead to the fact that multiple receptors located in the serous membrane of the organ are constantly irritated. In addition, pain can occur due to too frequent contraction of the walls of the gallbladder. The nature of the pain is dull and aching. They tend to give to the right hypochondrium, are present on a periodic basis. Provocateurs of pain can be alcohol-containing drinks, fatty foods and strong ones. That's why patients don't connect discomfort with polyps, attributing their occurrence to other factors, such as malnutrition.

Staining of the skin and mucous membranes in yellow. A similar symptom is the result of obstructive jaundice, which occurs when a bile duct polyp is clamped. Unable to exit naturally, bile begins to seep through the walls of the bladder and enter the bloodstream. The patient begins to experience skin, the integument becomes dry and tight, the urine darkens, it may begin with bile masses and the temperature rises.

Renal colic. If the polyp has a very long stalk and is located in the area of the neck of the affected organ, then it can develop when it is twisted or clamped. Most often this occurs with a pronounced contraction of the organ. When torsion has occurred, a person experiences sudden pain, which has a sharp cramping character, the heartbeat rises, blood pressure rises. At the same time, the patient cannot choose for himself a more or less comfortable position in order to somewhat calm the discomfort. It is the last sign that is a clear indicator of hepatic colic.

Dyspeptic symptoms. The presence of a polyp is most often indicated by symptoms. Its severity varies. Typical manifestations are: bitter taste, morning sickness, vomiting after overeating. All these manifestations are explained by periodic or constant congestion occurring in the organ. In addition, due to the polyp, there is a violation of the production of bile. Its deficiency negatively affects the digestion process, so the patient can begin to quickly lose weight.

However, all of the above symptoms rarely force the patient to go to medical institutions, and even more so to undergo an ultrasound examination, during which existing tumors can be detected.

Causes of polyps in the gallbladder

There are four reasons why polyposis growths in the gallbladder may presumably begin to develop:

Factor of heredity and anomalies of genetic development. Thus, heredity influences the growth and development of polyposis growths. Most often, adenomatous formations and papillomas are inherited. It has been established that even if other tumors are detected in close relatives, the risks of developing gallbladder polyps increase. In addition, a genetic predisposition to bile duct dyskinesia is a direct cause leading to the development of polyposis. However, it cannot be said that only genetic predisposition is the cause of tumor formation. It grows and develops under the influence of other factors. A burdened family history in this case is an additional provocateur for the manifestation of the disease.

Diseases of the gallbladder of inflammatory origin. Chronic are the most common reason for the development and growth of the polyp. In the organ against the background of cholecystitis, stagnation of bile occurs, its wall thickens and undergoes deformation. The granulation tissue of the bladder begins to respond to the inflammatory process. This reaction manifests itself in the form of proliferation of its cells. As a result, pseudo-polyps of inflammatory origin are formed in a person.

Failures of metabolic processes. The most common cause of the growth of cholesterol pseudopolyps are lipid metabolism disorders. As a result, a significant amount begins to circulate in the bloodstream. Its excess gradually begins to be deposited on the walls of blood vessels, as well as in the organ - the storehouse of bile. This leads to the formation of pseudopolyps consisting of cholesterol. In addition, such formations can appear even against the background normal concentration lipids in the blood, which is due to the cholesterol that is part of the bile. When conducting an ultrasound examination, it is precisely such pseudopolyps that are most often found. The longer a person is their carrier, the more they become. Their growth is facilitated by the absence of any symptoms that disturb a person.

Diseases of the hepatobiliary system. Any diseases of the biliary tract contribute to an imbalance between the optimal amount of bile necessary for digestion and its volumes allocated for this process. Both its deficiency and excess disrupt the process of digestion of food. This leads to various pathologies Gastrointestinal tract, including provoking the development of polyps.

Concomitant diseases in gallbladder polyps

Polyps of the gallbladder can provoke pathologies in the organs closest to it - the liver and pancreas. So, polyps are a potential focus for the development of infection, which give rise to the inflammatory process. This provokes cholecystitis, spasms of the biliary tract, and other diseases. In addition, inflammatory processes in the gallbladder themselves can contribute to the pathological growth of its mucosa.

What diseases are observed in gallbladder polyps?

Dyskinesia or spasms of the gallbladder duct. Dyskinesia, which is hypertonic in nature, in which the tone of the gallbladder increases, is more common in women and is usually closely related to the menstrual cycle. Hypotonic dyskinesia (insufficient intensity of contractions of the gallbladder) is common among middle-aged or older people. Dyskinesia leads to difficulty in the outflow of bile, which in chronic course can provoke cholecystitis or the deposition of stones in the gallbladder, and in addition, creates conditions for the formation of polyps. Also, the disease can be caused by dysfunction of the sphincter of Oddi, which separates the bile ducts from the duodenum.

Cholelithiasis- the formation of cholesterol stones in the liver, bile ducts or gallbladder, due to lipid metabolism disorders. The formation of cholesterol stones in the gallbladder begins with a violation of the chemical composition of bile - it lacks bile acids and phospholipids, but there is a glut of cholesterol and fatty acids. The causes of this disease can be obesity, an unbalanced diet, bile stasis, infections of the gallbladder and biliary tract. At the same time, cholesterol polyps of the gallbladder and other neoplasms of its mucosa can be observed.

Acute and chronic pancreatitis- an inflammatory disease of the pancreas, which in 65-60% of cases is observed with dyskinesia, spasms or dysfunction of the sphincter of Oddi, hepatic colic and cholelithiasis. Other causes of pancreatitis are the spread of the inflammatory process caused by infection from the gallbladder and its duct to the pancreas, the abuse of alcohol and food that causes increased pancreatic secretion.

What are polyps in the gallbladder?

Cholesterol polyps- tumor-like formations, which consist of cholesterol deposits with calcified inclusions, develop first under the gallbladder mucosa, after which it grows, forming a polyp. They are usually observed in people with disorders of fat metabolism with elevated level low density lipoproteins and a decrease in the concentration of HDL (high density lipoproteins). They are quite common, they are discovered by chance during the examination, since their formation and growth are asymptomatic.

Inflammatory polyps- the cause of their formation is the inflammatory process, which can develop as a result of a bacterial infection. On the inner membrane of the gallbladder, an overgrowth of granulomatous tissues in the form of a tumor is formed.

Adenomatous polyps- true tumors, benign, but with an increased risk of malignant degeneration. The cause of adenomatous polyps and papillomas is the growth of glandular tissue, in 10% of cases they degenerate into oncological formations, which causes concern among doctors and requires constant monitoring of their growth and immediate treatment.

Papillomas are also benign tumors, usually small in size and characterized by papillary growths.

Diagnosis of polyps in the gallbladder

The detection of pathological growths in the gallbladder has become possible due to the development of radiology since the thirties of the twentieth century. Since then modern medicine in this regard, has made several steps forward, and more accurate and harmless diagnostic methods are available to patients.

In most medical institutions, ultrasound and endoscopic ultrasonography are used to diagnose polyps:

Ultrasound can detect single or multiple polyps of the gallbladder mucosa. They appear on the screen of the apparatus as rounded formations associated with the walls of the bubble without an acoustic shadow. When changing the position of the patient's body, the polyps do not move.

Ultrasonography is to research duodenum and gallbladder using a flexible endoscope. The device is swallowed by the patient, at its end there is an ultrasonic sensor, with the help of which the walls of the gallbladder are examined for the presence of growths. An important role in the detection of various details is played by the operating frequency of the sensor - the higher it is, the more detailed the resulting image. This method allows you to get a better image, respectively, and the diagnostic data is more accurate.

In addition, a CT scan called magnetic resonance cholangiography is available in some hospitals. This is the most progressive method at the moment, thanks to which the doctor can not only see, localize and evaluate the size of the neoplasm, but also identify the presence of concomitant formations that occur during the malignancy of the polyp. To assess the amount of contrast agent accumulated by tumor tissues, multislice computed tomography may be additionally prescribed.

Due to the breadth of application modern methods diagnostics, statistics of cases of gallbladder polyps was compiled, which showed that approximately 4% of the population are their permanent carriers, of which the predominant part (60%) are women aged 30 years and above.

Answers to popular questions

Can a polyp in the gallbladder dissolve? In 95% of cases, the detected polyps are loose cholesterol formations, which makes their conservative treatment with choleretic drugs, which include ursosan and ursofalk, possible. Medicines that thin bile promote the resorption of polyps in the submucosal layer of the gallbladder.

Is it possible to remove only the polyps themselves while maintaining a functioning gallbladder? It is impossible to remove a polyp without damaging the walls of the gallbladder, so even if the doctor saves the organ, its function will be impaired, and polyps will reappear after a while, possibly in greater numbers than before the operation. This practice has been abandoned for a long time. Already in the 70s of the last century, they stopped performing operations that preserve the gallbladder after the removal of neoplasms from it. In addition, at one time there was a popular method of crushing stones (lithotripsy). However, this treatment technique turned out to be meaningless, since after a while 99% of patients had a relapse of the disease. In the future, they were helped only by surgical intervention with the removal of the organ. Therefore, the optimal method of treatment is surgery, namely, laparoscopic cholecystectomy.

However, removal of the gallbladder is not the only way out, most neoplasms are amenable to conservative treatment. The patient is required to regularly undergo diagnostics twice a year to prevent the malignancy of polyps and the onset of the cancer process. The danger is growths greater than 10 mm, which do not stop growing; if a small polyp has increased in a year and has become twice its original size, this may indicate the onset of malignancy. Neoplasms with a wide base that do not have a pronounced pedicle are more prone to malignant degeneration. With polyps larger than a centimeter, an operation is prescribed to remove the gall. In other cases, you can get by with choleretic drugs and correction of diet and lifestyle.

Can a polyp in the gallbladder hurt? Pain in gallbladder polyps is usually associated with the formation of cholesterol stones or are symptoms of cholecystitis. Polyps in the gallbladder usually do not cause pain.

Is it possible to visit a bath or sauna with polyps in the gallbladder? With polyps in the gallbladder, it is impossible to warm up the area of \u200b\u200bthe organ, therefore it is not recommended to go to the bath or sauna, spend a lot of time in the sun.

What to do if polyps are found in the gallbladder?

In 95% of cases, neoplasms diagnosed as polyps are actually cholesterol calculi - loose stones that can dissolve under the action of bile.

The treatment is carried out with chenodeoxycholic and ursodeoxycholic acid, which stimulate the mechanism of bile formation and improve the quality of bile, which contributes to the dissolution of cholesterol stones. A three-month course of treatment is prescribed, the dosage is calculated at 10 mg per 1 kg of the patient's weight, taken in the evenings two hours after the last meal. Treatment with bile acids is combined with a diet according to table No. 5

After the end of the course of treatment, a control ultrasound is performed and conclusions are drawn about the need for surgery. If the growth of formations slows down, their number or size decreases, then conservative methods treatment is effective in this case.

Treatment of polyps in the gallbladder without surgery

First of all, you need to contact a gastroenterologist and conduct all the necessary diagnostic examinations in order to determine the type of polyps, their size and the risk of malignancy.

Cholesterol polyps are the most common type of neoplasm in the gallbladder. timely treatment pose no great danger.

Cholesterol polyps occur as a network of small inclusions of 1-2 mm, diffusely distributed along the inner wall of the organ, or they can be up to 4 mm in size and look like outgrowths with even contours and a wide base on ultrasonography. Polyps larger than 4 mm already have a thin stalk.

Ursofalk, which promotes the destruction of deposits, consisting of cholesterol.

Simvastatin helps lower blood levels of lipoproteins and cholesterol.

Gepabene and No-shpa are used as adjuvants to help relax the smooth muscles of the gallbladder. Spasm is relieved from the organ, bile has the ability to normally pass through the ducts and take part in the process of digesting food.

Holiver increases the ability of the gallbladder to secrete bile and eliminates congestion.

Ursosan allows you to eliminate cholesterol stones, if the gallbladder has not lost its ability to function.

Multiple cholesterol polyposis may actually be not growths, but loose cholesterol stones, which subsequently cause pain in the patient. Common complaints in this case are sensations, nausea and pain in the right hypochondrium, symptoms of cholecystitis caused by cholesterol stones.

Treatment of cholesterol polyps can be carried out conservatively if the growth height is not more than 10 mm.

A surgical operation to remove polyps or the entire gallbladder is prescribed only as a last resort, if there are many neoplasms and they are constantly growing. In most cases, doctors try to save the organ, since its absence can provoke digestive disorders and make it difficult to digest fatty foods.

Surgery for polyps in the gallbladder

The oncologically tense situation of our time requires careful control over any neoplasms in the body, otherwise there is a risk of oncological degeneration of tissues. If a course of conservative treatment did not work, or large polyps were found during the first diagnosis, an operation is indicated.

Indications for surgical treatment polyps:

High growth rate of polyps - from two mm per year;

The size of the neoplasm is from 10 mm;

A large number of growths with a wide base without a leg.

If the size of the polyps is less than 1 mm, surgery is not needed, but a preventive examination is necessary monthly for six months, and then every three months. If the neoplasms do not increase in size, then further diagnostics are carried out every six months.

Types of operations on the gallbladder:

Videolaparoscopic cholecystectomy (LCE)– is considered the most gentle for the patient, uses modern technologies endoscopy.

Laparoscopic cholecystectomy– removal of the gallbladder without an incision, as in traditional cholecystectomy using instruments for endoscopic operations. It is considered the "gold standard" of modern surgery, but in five percent of cases the operation cannot be completed and a traditional cholecystectomy is performed.

Conventional cholecystectomy (TCE)– by open surgery, access is through the upper midline or Kocher incision in the right hypochondrium. The disadvantage of this method, in comparison with laparoscopic cholecystectomy, is its invasiveness - the incision cuts through the skin, fatty tissue, white line of the abdomen and peritoneum.

Endoscopic polypectomy- used to remove polyps of the gallbladder while preserving the organ. This type of operation is performed using a diathermic loop, which is thrown over the leg of the polyp and cut off. Formations without a leg are removed by fragmentation. An electric charge is passed through the loop in order to coagulate the vessels, which helps to avoid bleeding. This method is used to remove polyps in the intestines, but it is rarely used in the treatment of gallbladder polyposis, so the consequences can be unpredictable.

Preparation for cholecystectomy

Before the operation, the patient must undergo a comprehensive diagnostic examination to avoid possible complications and choose the optimal method of cholecystectomy.

What diagnostic procedures should be carried out before the operation:

Ultrasound procedure liver, gallbladder and pancreas, which allows you to identify concomitant diseases and inflammatory processes, evaluate the number of polyps, their size and type, determine the presence of stones in the liver and gallbladder;

CT scan allows you to assess the state of the tissues surrounding the gallbladder, determine the state of its mucosa, the presence of adhesions and scars, examine the state of its wall for thickening and nodular formations;

MRI is one of the most reliable methods for studying polyps and stones in the gallbladder, which allows timely detection of adhesions, inflammation, pathology of the biliary tract;

Diagnosis of the state of the cardiovascular and respiratory systems using radiography and ECG allows you to correctly prescribe a treatment regimen; - a serious contraindication for some methods of cholecystectomy.

Preparatory procedures necessary for the patient immediately before the operation:

Eliminate blood-thinning foods from the diet, stop taking drugs that affect blood clotting, such as aspirin - this is necessary to minimize the risk of bleeding during surgery.

On the day of the operation, do not eat and drink liquids, even water is excluded.

The night before the operation, it is necessary to cleanse the intestines using an enema or laxative;

Immediately before the operation, thoroughly cleanse the body using antibacterial soap.

Can you live without a gallbladder?

All human organs can be conditionally divided into vital (like the brain, heart, liver, etc.) and organs without which life is possible, but the functionality of some systems will be impaired. These organs include the spleen, gallbladder, appendix, and stomach. Despite the fact that a person can easily live without these organs, subject to a strict diet and limiting stress on the body, it is not recommended to remove them without a compelling need.

Removal of the gallbladder is carried out only if its pathology threatens the entire body as a whole. Thus, a large number of polyps with an accelerated growth rate and an increased risk of malignancy can lead to gallbladder cancer with metastases to other internal organs. In this case, removal of the gallbladder or cholecystectomy is a matter of life and death. This is an absolute indication for surgery.

There are also relative indications for surgery: when gallbladder pathologies do not threaten life, but noticeably worsen its quality. So, for example, if polyps in the gallbladder cause pain or are a source of infection. If a person constantly has to be afraid of pain or potential risk malignant degeneration of polyps and cancer, it is better to have surgery. After a successful operation and a rehabilitation period, the patient has a chance to return to a full life.

Rules of conduct after removal of the gallbladder

After the operation, the patient will have to slightly change the way of eating. The fact is that, thanks to the gallbladder, bile accumulates in the liver, and its concentration increases. In the absence of this organ, the digestive juice is sent directly to the intestines, and its concentration remains quite low. Removal of the gallbladder also affects the activity of enzymes - it is significantly reduced. It takes about two years for the body to fully adapt to a new way of digestion without the help of a remote organ.

For the first six months after the operation, it is necessary to strictly monitor the diet:

The first rule is that you can only eat boiled or steamed food.

The second rule is to take food in small pieces, chewing it slowly and thoroughly. This will give the liver time to activate all the necessary enzymes and start working.

The third rule is to reduce the amount of food consumed at a time, but increase the number of servings. Otherwise digestive system will not have time to cope with its functions, and nausea, heaviness in the intestines will appear. Another negative consequence of violating this rule is stagnation of bile, which can occur in the ducts even after removal of the bladder.

After six months of strict abstinence, fresh vegetables and fruits, as well as dietary meat and fish, can be included in the diet. Although excessively acidic, spicy and essential oil-rich foods (onions, sour berries, etc.) must be abandoned for another 12-18 months.

Two years after the removal of the gallbladder, the digestive system becomes strong enough for the patient to return to his usual diet, excluding refractory fats (heavy meat and lard), although the second and third rules are best adhered to for life.

Physical activity after gallbladder surgery

After two to three months of the postoperative period, the patient is strongly advised to take regular walks, taking at least half an hour a day. This is the very first and affordable way avoid bile stasis.

Six months later, the patient can sign up for a pool or go swimming in the warm season on their own - regular soft massage with water almost completely eliminates the risk of stagnation.

At the same time, morning exercises are allowed, but this does not apply to the abdominal muscles. Significant tension of the muscular corset is recognized by doctors as safe only a year after the operation.

The problem with the microflora after cholecystectomy

A decrease in the concentration of bile also affects the microflora small intestine- microbes get the opportunity to multiply more intensively and provoke attacks, and. To stop the reproduction of opportunistic and pathogenic microflora change the nature of the diet (exclude sweets from the diet), maintain a healthy microflora by regularly taking prebiotics and food with bifidus and lactobacilli. To solve this problem, you can also contact a gastroenterologist for advice on the selection medicines that destroy intestinal microbes without harm to the body.

Diet for polyps in the gallbladder and after removal

In diseases associated with insufficiency of the liver and gallbladder, the doctor must prescribe dietary table No. 5 or report on its basic requirements without specifying the diet, for example, simply says: “no fried, spicy, smoked, pickled”, etc. In any case, a patient with polyps in the gallbladder needs to know how to maintain his health by protecting himself from foods that are hard on the liver.

Diet tables were invented by the founder of medical dietology, the Soviet scientist Manuil Pevzner. Despite the venerable age of research conducted to develop diets in the 30-50s of the 20th century, in the USSR, and then in the CIS countries, dietary tables are prescribed to this day, since their effectiveness has been time-tested and leaves no doubt.

Diet #5 consists of foods that provide a complete daily serving of protein, carbohydrates, and calories while limiting fat intake. When eating certain types of food, the patient's condition may worsen, which is why they should be excluded from the diet. The consumption of food that unnecessarily stimulates the pancreas and the secretion of the stomach itself is also limited.

The ultimate goal of the diet is not only the weakening of the chemical load on the liver, but also the speedy removal of cholesterol, due to the improvement of intestinal motility and the choleretic properties of food components.
The diet should be followed so that the optimal daily calorie intake is maintained (for an adult - from 2200 to 2600 kilocalories, depending on the severity of physical labor performed regularly). In addition to the calorie content of food, the amount of food is extremely important, since even light and liquid foods taken in large portions can overload the gallbladder.

If polyps are found in the gallbladder, which often occurs by chance during a comprehensive examination, it is not necessary to consult a doctor in the first stages of the disease. The patient can adhere to this diet on his own, so as not to bring the disease to the need for surgical intervention and increase the effectiveness of conservative treatment.

What can you eat?

Flour - black and white bread, only yesterday's baking or dried to crackers. It is permissible from time to time to pamper yourself with dry cookies or biscuits. No more than twice a week it is allowed to use well-baked buns or pies without butter in the dough;

Meat is just lean. If it is beef, then boiled, you can also eat tongue and ham. If the bird is dietary (chicken, turkey), only fillets (breasts) are desirable, but other meaty parts are also allowed to be boiled. Fish must be steamed or boiled, caviar and milk can be added only in small quantities as a flavor enhancer. When possible, boiled meat and fish can be additionally baked to improve the taste.

soft-boil eggs, consume no more than one per day. It is best to cook an omelet from it. If the omelette is large, it is necessary to divide it into parts and eat so that you get only one egg per day (for example, divide a dish of four eggs into four parts and do not eat more than one per day);

Vegetables with greens can be eaten both raw and boiled. It is useful to use vegetables as side dishes and full meals, especially if it is;

Cerealsboiled in water or with milk, as well as pasta;

Fruits and berries - only sweet and preferably in the composition of jelly or compote, sour fruits are excluded from the diet. Baking and steaming fruits is not prohibited;

Dairy products can be eaten no more than 200 g per day. It can be low-fat raw foods (cottage cheese, kefir, milk, yogurt, mild cheese). It is also allowed to cook casseroles, dumplings, soufflés, cheesecakes, processed cheese from them.

Vegetable oil- no more than two tablespoons per day, use only as a dressing for vegetable salads and other prepared meals.

Among sweets, you should choose natural honey, jam, marshmallows, marmalade, but not more than 70 g per day;

Sauces based on milk, berries and fruits;

Drinks: rosehip infusion, herbal preparations with choleretic action;

Among spices, give preference to greens (,), and.

Food is divided into small portions, the number of meals daily is at least five. You can not eat cold or very hot food, this can provoke irritation of the intestinal mucosa. Drink at least 1.5 liters of fluid daily, drink before each meal, this contributes to the release of bile, preventing its accumulation and stagnation. Minimize the amount of salt consumed. Food, if possible, should be crushed before eating.

What can't be eaten?

Under the ban are refractory fats and products containing them - lard, lamb, pork; a small amount of butter in the diet is acceptable;

Smoked meats, spicy, pickled, canned food;

Among greens and vegetables - exclude from the diet, onions, garlic, radishes and sorrel;

All legumes;

Among dairy products, sour cream is prohibited;

Sweet pastries;

Chocolate, cocoa and ice cream;

Any carbonated drinks;

Vinegar, spices and spices;

Restriction of salt intake - no more than 10 g per day;

Any alcohol.

Education: Diploma in the specialty "Medicine" received at the Russian State Medical University. N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.

The situation is aggravated by the fact that in this disease there are no specific symptoms. Some doctors say that a mandatory operation is required, others are less categorical. They argue that if you have gallbladder polyps, treatment without surgery is possible. Who is right in this situation? Let's try to figure it out.

Symptoms of gallbladder polyps

What is a gallbladder polyp? These are growths on the inner wall of the organ. When they are in the plural, it is polyposis. It is dangerous that these benign formations can develop into cancer. Unfortunately, they do not have pronounced symptoms. The appearance of pain on the right, in the hypochondrium, heaviness when eating, nausea - all the same is manifested in diseases of the liver, cholelithiasis. Diagnostics, except for ultrasound, does not exist, and formations are detected by chance.

It is important!

Tired of papillomas and warts? Time to get rid of them! - More.

Distribution have cholesterol polyps of the gallbladder. Their reason is simple - cholesterol is deposited on the inner walls of the organ. In inflammatory formations, diseased tissue grows. Papillomas look like papillae. The most dangerous - adenomas - the growth of cancer cells. There are several reasons for this:

accumulation of cholesterol;
obesity;
taking hormones;
stagnation of bile;
eating fatty, fried foods.

Treatment without surgery

How to treat a polyp in the gallbladder? A single growth up to 5 millimeters is not dangerous. When their dimensions are from 5 to 10 millimeters, constant medical supervision is required. Therapy is needed in order to exclude an increase in growths. Prescribe medications: "Allochola", "Holenzima", bear bile. At the same time, a strict diet, treatment with folk remedies is recommended. See what the growth looks like in the photo.

When the formations increase in size, become more than 10 millimeters, an endoscopic gallbladder polypectomy is performed. During this operation, only the growth is removed, and the organ itself remains intact, continues to work normally. Only when the size of the formations is more than two centimeters, it is recommended to remove the diseased organ, because the likelihood of cancer is high. The operation is fast, after 2 days the patient continues outpatient treatment at home. According to the international ICD-10 classification, diseases with such neoplasms have the code K80-K86.

diet

In addition to taking medications, a diet is prescribed. With polyposis, she is very strict. The diet eliminates fatty and smoked foods, limits the use of sweets and honey, and reduces the amount of salt. The following products are completely excluded:

Diet for polyps in the gallbladder suggests fractional nutrition- five times a day. It is necessary to drink plenty of water, up to two liters, so that the bile becomes less thick. It is recommended to add bran rich in fiber to food. Allowed: