RU2333020C1 - Method of after treatment of patients with postcholecystectomy syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: operative intervention area is treated by the polychromatic polarised light from the stationary apparatus "Bioptron-2" in a range from 400 nanometers to 2000 nanometers. Thus density of a stream totals 40 mW/cm², densities of a stream of light energy totals 2.4 J/cm² per minute. Treatment starts for 10-12 days after operation. The ray of light is pointed at the right hypochondrium from distance by of 20 cm within 6 minutes. Then a ray of light is pointed at an area over acanthas D6 - D10 vertebra from the distance of 20 cm within 4 minutes. Time of the procedure takes 10 minutes. The same day the eyes are additionally treated with dark blue light from "АПЭК" apparatus with wavelength 430±30 nanometers. Duration of impulse of light 3.5-4 with frequency of following of impulse of intraimpulsive modulation equals 9.2±0.2 Hz within 10 minutes. The course makes 15 daily procedures.

EFFECT: method allows to restore a functional condition of the interfaced digestion organs and to normalise metabolic processes as a whole.

3 tbl, 2 ex

Description

The invention relates to medicine, in particular physiotherapy in the rehabilitation system of patients with the phenomena of postcholecystectomy syndrome who underwent surgery to remove the gallbladder due to calculous cholecystitis.

According to modern statistics, every tenth man and every fourth woman is sick with chronic calculous cholecystitis (gallstone disease). Up to 40 years, women are more often sick, then the incidence rate of men and women becomes almost the same. Of all inflammatory diseases of the gallbladder, the incidence of calculous cholecystitis is 80-90% and is the cause of surgical interventions, which occupy the second highest frequency among surgical operations of the abdominal cavity, second only to appendectomy (A.G. Kulikov, R.M. Filimonov, V. A. Maksimov et al. - Cholecystectomy: the need and principles of rehabilitation treatment. - in. VKF and LFK. - 2000. - No. 1. - p.30-32).

Due to the fact that the formation of gallbladder stones takes more than one year, before its removal, the associated organs of the digestive tract are involved in the pathological process. As a result of the chronic course of cholecystitis, the stomach is almost always affected to one degree or another. With a long course, the nature of gastric secretion changes (there is hyperacidity, and then hypacidity), and when conducting fibrogastroscopy, morphological changes are always detected: duodenogastric reflux and other more pronounced complications of the course of the disease occur. Over 50% of patients have impaired exocrine pancreatic function, since the common bile duct passes through pancreas. Antitoxic, protein-synthetic, including prothrombin-forming liver function, pigment, carbohydrate and fat metabolism are violated (V. S. Petrakova. - Sat: “Siberian balneology and physiotherapy in the concept of development of healthcare and medical science of the Russian Federation”, materials of scientific conference . (September 18, 19, 2002) .- Tomsk, 2002. - p. 189-190); Standards (protocols) for the diagnosis and treatment of digestive organs. Moscow, 1998 (Approved by the Ministry of Health of the Russian Federation of 04.17.1998. No. 125, Order No. 190/355 of September 14, 2001 “On aftercare of patients in a sanatorium”, 17 pp.). As a result, removal of the gallbladder is not a disposal of existing organic and functional disorders in the postoperative period, referred to as postcholecystectomy syndrome (PCES).

The clinical manifestations of PCES are diverse. Pain syndrome resembling hepatic colic, sometimes with jaundice, itching of the skin, discoloration of urine and stool, is characterized by girdle pain. In the interictal period, patients often notice constant, dull pain in the right hypochondrium and epigastrium, decreased appetite, constipation, nausea, vomiting, bitterness in the mouth. The manifestations of asthenovegetative syndrome are expressed - weakness, fatigue, irritability, poor sleep.

Thus, taking into account the recurring course of the disease, complications from other digestive organs, a high percentage of repeated reconstructive operations and patient disability, it becomes clear how relevant the early rehabilitation of patients after surgery. The earliest possible inclusion of natural and preformed physical factors into the rehabilitation complex is advisable, since they help stimulate self-healing processes, increase the nonspecific resistance of the body, adaptive capabilities, have a multilateral effect on the body in the absence of pronounced side effects and allergic reactions (Petrakova BC, Ugolnikova O.I. ., Beloborodova E.I. et al. “Sanatorium-resort factors in post-gastro-resection disorders and conditions after ud Lenia gallbladder "manual for physicians, Tomsk - 2003, page 3-4).

However, rehabilitation measures by natural factors in the period of aftercare were developed only at a later date: 6-12 months after the operation (there is no data on earlier rehabilitation), although it is necessary to normalize the functional state of the digestive organs pathogenetically in the early period of adaptation to new conditions of digestive secretory activity a path that will prevent further development of PCES.

There is a method of rehabilitation of patients with PCES after 6-12 months with mineral waters and peloid applications in a spa. The method consists in the fact that 6-12 months after the operation of cholecystectomy, a complex is carried out consisting of an internal intake of sulfate-chloride-sodium-magnesium water, total mineralization of 5-10 g / l, 3 times a day 30-40 minutes before meals a temperature of 38-40 ° C, 50-100-150 ml; iodine-bromine baths T +36 + 37 ° С, 7-10 min, daily, 10-12 procedures and mud applications with a “wide belt” with capture of the epigastric region, left and right hypochondria and back area at the level of D6 - D10 with alternating T +36 ° С and 40 ° С every other day, 10-15-20 min, daily, 8-10 procedures (Petrakova BC, Ugolnikova OI, Beloborodova E.I. et al. “Sanatorium-resort factors in post gastroresection disorders and conditions after removal of the gallbladder ”, a manual for doctors, Tomsk - 2003, p.11).

However, this method is effective in the late period of rehabilitation treatment of the existing PCES, which can be prevented by an early course of rehabilitation measures.

The closest in technical essence is the method of applying a magnetic field in the early postoperative period, the essence of which is that a magnetic field inductor from a portable device is applied to the area of the surgical wound through a dressing without a gap, the pulse mode, the procedure time is 10 minutes, daily up to 6 - 10 procedures (I.N. Sosin, A.K. Palamarchuk. - Clinical physiotherapy. / Edited by I.N. Sosin. - KIIV: Zdorovya. - 1996 - p.261). The method improves blood circulation, has an anti-inflammatory and absorbable effect, relieves pain, stimulates regenerative processes, improves trophic abdominal tissue.

However, this method has disadvantages:

- contraindications with a tendency to bleeding or the threat of bleeding at the site of surgery;

- applied only in the early stages after the operation is carried out in a short course;

- dyspepsia syndrome persists in the form of bitterness in the mouth, severity in the epigastrium, nausea up to 12-18 months;

- pain remains in the form of dull pain in the epigastrium up to 14-18 months;

- Intestinal dyspepsia syndrome persists with flatulence, intolerance to the milk diet, alternating diarrhea with constipation during the first 2 years of observation;

- there is a gradual atrophy of the gastric mucosa in 88% of the operated patients due to bile reflux.

SUMMARY OF THE INVENTION

Prevention of the development of GTEC in patients after cholecystectomy for calculous cholecystitis by accelerating the normalization of the functional state of the digestive system and metabolic processes, as well as increasing the adaptation of the central nervous system at the perestroika stage for the patient’s body, which adapts to new conditions that have developed during his illness and subsequent surgery.

The task is achieved by the fact that they rehabilitate patients with postcholecystectomy syndrome, including exposure to a physical factor in the area of surgical intervention. Exposure begins 10-12 days after surgery. As a physical factor, they are exposed to polychromatic polarized light from a Bioptron-2 stationary apparatus containing various wavelengths in the range from 400 nm to 2000 nm with a power flux density of 40 mW / cm ² and a light energy flux density of 2.4 J / min cm ^{2. The} light beam is sent to the right hypochondrium from a distance of 20 cm for 6 minutes, then the light beam is sent to the area above the spinous processes D6 - D10 of the vertebrae from a distance of 20 cm for 4 minutes, the exposure time for the procedure is 10 minutes, daily, in a course 15 treatments. day e additionally affect the eyes with blue light from the APEC apparatus with a wavelength of 430 ± 30 nm, a light pulse duration of 3.5-4 s, a pulse repetition rate of 9.2 ± 0.2 Hz for 10 minutes, daily, a course of 15 procedures.

The novelty of the invention:

- Exposure begins 10-12 days after surgery.

- As a physical factor, they are exposed to polychromatic polarized light from a Bioptron-2 stationary device.

- A ray of light is sent to the right hypochondrium from a distance of 20 cm for 6 minutes, then a ray of light is sent to the area above the spinous processes D6 - D10 of the vertebrae from a distance of 20 cm for 4 minutes.

- On the same day, they additionally affect the eyes with blue light from the APEC apparatus.

The proposed method prevents the development of PCES after removal of the gallbladder due to:

- the disappearance of cholestatic manifestations (normalization of alkaline phosphatase, cholesterol);

- normalization of serum enzyme activity;

- normalization of fat metabolism;

- normalization of exocrine pancreatic function;

- elimination of duodenogastric reflux;

- normalization of the morphological picture of the gastric mucosa and duodenum;

- normalization of the clinical picture of the postresection period.

The criterion for choosing the effect on the areas of surgical intervention of the right hypochondrium and segmental innervation by polychromatic polarized light was its biophysical effect on tissues. As a result of using polarized light, the most important biostimulating effect for rehabilitation is manifested. Its manifestations are noted, first of all, in the basal layers of the skin and are expressed in the activation of mitoses of cells, the accumulation of energy-rich phosphates, and the acceleration of the consumption of oxygen and glucose by tissues. At the same time, the temperature rises in tissues by 1.0-1.5 ° C and microcirculation improves. Polarized light causes stabilization of the cell membrane, normalization of its conformation and charge, stimulates it to perform specific functions (receptor, transport, barrier). Anti-inflammatory effect is inherent in biopronthotherapy due to the improvement of regional blood flow and lymph outflow, increased metabolism in the cells, which is extremely important in the postoperative period. In addition, polarized light has a pronounced decongestant effect due to improved microcirculation and a change in the colloidal properties of biopolymers. The increase in the adaptive properties of the body is manifested in the normalization of adaptation reactions due to stimulation of the immune system. So the local application of polarized light increases the level of Langerhans cells in the skin, which increases the synthesis of immunoglobulins, activates phagocytosis, increases the content of lymphocytes, monocytes, eosinophilic granulocytes at the site of irradiation. Elimination of tissue hypoxia and elimination of perineural edema, reduction of impulse activity of nerve endings of C-afferents contributes to a pronounced analgesic effect at the place of use of peiler therapy (Ulashchik BC, Lukomsky IV - General physiotherapy. - Minsk. - Book House. - 2003. - p. 162-165).

The criterion for the choice of ophthalmic chromotherapy with a narrow-band range of electromagnetic radiation of the blue spectrum in the alpha rhythm mode was the mechanism of bioresonance effects on the patient's body through a visual analyzer. It has a harmonizing effect on various hierarchical levels of body frequencies, increasing immunity and the body's own defenses, which allows achieving homeostasis. Moreover, this technique has a synergy with the above factor. Blue light affects the pituitary gland, parasympathetic nervous system, has antibacterial properties. The psycholeptic effect of blue color includes sedative, muscle relaxant and hypnotic effects. Calmness, muscle relaxation appears, the pace of thinking, speech-motor activity, expression of speech decrease, anxiety decreases. (Chromotherapy of diseases of the organs of vision, stress and psychophysiological disorders. - Methodological recommendations. - B.N. Burenko, V.A. Zverev. - Tomsk - 2003. - 14 p.).

For comparison, similar indicators of the main and control groups are presented. The main group included 24 patients after cholecystectomy for calculous cholecystitis, who received treatment by the present method. The control group included 21 patients who underwent a similar operation who received treatment according to the prototype. As can be seen from tables 1, 2, 3, the functional state of the digestive system and metabolic processes as a whole are significantly improved by local exposure to polarized light in combination with ophthalmic chromotherapy in all patients, which proves the recovery effect of the proposed method.

The use of the effect of polychromatic polarized light on the right hypochondrium and segments of the spinal cord reflexively connected with the digestive organs, as well as the use of blue ophthalmic chromotherapy in the frequency range of the alpha rhythm of brain cells, allowed to obtain a new result

- eliminate cholestatic manifestations, as can be judged by the normalization of the level of alkaline phosphatase in blood serum from 283 ± 2.1 U / L to 223.3 ± 2.2 U / L (P <0.01) in the main group against the lack of dynamics in the prototype treatment group (283.4 ± 2.1 U / L and 281.1 ± 2.0 U / L P> 0.5); the cholesterol level of the low-density lipoprotein fraction (LDL) from 3.94 ± 0.9 mmol / L to 3.23 ± 0.02 mmol / L (P <0.01) versus 3.98 ± 0.8 mmol / L to 3 , 94 ± 2.2 mmol / L P> 0.5 in the treatment group of the prototype (Table 3). An ultrasound study confirmed the elimination of hepatic cholestasis in the main group (echogenicity was increased, after treatment became average; sound conductivity was reduced, after treatment was preserved; the vascular pattern was depleted before treatment, was not changed), while in patients treated with the prototype dynamics not observed (table 1).

- normalize the activity of serum enzymes: thus, before treatment, the indicator of patients in the main ALT group corresponded to: M.47.6 ± 0.5 U / L, Zh. 43.2 ± 0.3 U / L; ACT - M.46.9 ± 0.6 U / L, W.40.7 ± 0.4 U / L, and after treatment there were significant differences (P <0.01): ALT M.37.6 ± 0 , 11 U / L, W, 33.2 ± 0.4 U / L; ACT M.38.1 ± 0.63 U / L, W.32.1 ± 0.1E / L, receiving treatment according to the prototype, no reliable dynamics were observed (Table 3).

- normalize fat metabolism: the level of total cholesterol before treatment in the main group was determined as 6.78 ± 0.9 mmol / l with a predominance of the LDL fraction over HDL (P <0.01), after treatment normalization of the cholesterol indicator with an increase in HDL level was noted ( 1.38 ± 0.02 mmol / L P <0.01) and a decrease in LDL 3.23 ± 2.2 mmol / L P <0.01), while in the group of patients treated with the prototype positive dynamics not noted; serum triglycerides in patients of the main group reached a normal level (from 1.78 to 1.54 mol / L P <0.01) while in patients of the control group normalization was not observed (before treatment 1.84 mol / L after treatment, 1.77 mol / L P> 0.5) (Table 3).

- normalize exocrine pancreatic function: before treatment, both groups had an increased level of serum alpha amylase (96.7 ± 1.1 U / L in the main group and 95.6 ± 1.5 U / L in the control), which normalized after treatment, only in patients of the main group (66.3 ± 1.5E / L P <0.001) (Table 3).

- normalize the morphological picture of the mucous membrane of the stomach and duodenum, as evidenced by fibrogastroscopic examination of the stomach and duodenum. Prior to treatment, all patients had a change in the gastric mucosa in the form of hyperemia, on the mucosa of the duodenum 12 the curdled contents were revealed. In the stomach cavity there was mucus mixed with bile, the presence of reflux of duodenal contents in the stomach. After treatment, no positive dynamics were observed in the control group, while the mucous membrane of the stomach and duodenum was not changed in the patients of the main group, the contents of the stomach had no impurities, and duodenogastric reflux was absent (Table 1).

- normalize the clinical picture of the post-resection period in patients of the main group: epigastric pain disappeared, nausea, intolerance of any products were not observed, the phenomena of flatulence and intestinal dyskinesia in the form of weakening or delayed stools, bitterness in the mouth disappeared, sleep and mood normalized, performance increased .

The method is as follows.

Exposure to a physical factor begins 10-12 days after surgery.

The patient is sitting on a chair or lying on a couch, the lamp of the Bioptron-2 apparatus (Switzerland) is installed at a distance of 20 cm from the surface of the epigastrium and light therapy is carried out with light containing various wavelengths in the range from 400 nm to 2000 nm at a power flux density of 40 mW / cm ² light flux density per minute 2.4 J / cm ² for 6 minutes. Then the lamp is installed on the side of the back surface of the back at a distance of 20 cm and the light beam is directed to the area above the spinous processes D6 - D10 of the vertebrae and is illuminated for 4 minutes. The exposure time for the procedure is 10 minutes, daily, for a course of 15 procedures. Then the patient on the same day in a sitting or lying position additionally undergo an ophthalmic chromotherapy with blue light from the APEK apparatus. For this, the patient wears special impermeable glasses. LEDs are placed in the glasses. They are exposed to the eyes with blue light with a wavelength of 430 ± 30 nm, a pulse duration of 3.5–4 s, a pulse repetition rate of 9.2 ± 0.2 Hz for 10 minutes, daily, with a course of 15 procedures.

Under observation were 24 people aged 37 to 69 years. Of these: 16 women and 12 men after cholecystectomy surgery for calculous cholecystitis. All patients entered the course of rehabilitation therapy 8-12 days after surgical treatment. Before and after treatment, all patients underwent fibrogastroduodenoscopy and ultrasound of the abdominal organs, a study of blood serum indices for the level of total cholesterol and its fractions of HDL and LDL, triglycerides, transaminase activity (ALT, ACT), alpha-amylase.

The results showed that the proposed method has a pronounced positive effect on the restoration of the functional state of the paired digestive organs involved in the pathological process for many years prior to the operation, as well as on the normalization of metabolic processes in general (Tables 1, 2, 3).

The above indicators of the study of the digestive organs using fibrogastroscopy and ultrasound of the stomach, liver, pancreas and duodenum before and after surgery in patients of the main group clearly indicate a pronounced restoration of the digestive organs after surgery to remove the gallbladder compared to patients in the control group, not receiving early rehabilitation treatment according to the proposed method (Tables 1 and 2).

Example 1. Patient L. Year of birth 1957, observation history No. 18. Received rehabilitation treatment on day 12 after discharge from the surgical department with a diagnosis of the main: cholelithiasis, acute calculous cholecystitis, laparoscopic cholecystectomy; concomitant diagnosis: atrophic erosive gastritis, arterial hypertension. Sick for 8 years, when they began to worry about pain and heaviness in the epigastrium, nausea associated with eating (especially oily and acute). In the last 2 years, pain began to be paroxysmal acute. An ultrasound scan revealed gallbladder stones. In connection with the increase in paroxysmal pain, a planned operation was performed to remove the gallbladder by the endoscopic method. The postoperative period was uneventful and on the 7th day the patient was discharged from the department, and then was admitted for early rehabilitation treatment at the Federal State Institution Central Administration of the Social Insurance Fund of the Russian Federation “Topaz”. A study was carried out of the state of the digestive system and blood serum indices before the course of treatment. During a fibrogastroscopic examination, the following changes were noted: the mucous membrane of the cardial stomach was hyperemic, there was mucus mixed with bile in the stomach, reflux of the duodenal contents into the stomach, the gastric mucosa was brightly hyperemic, the edematous, duodenal mucosa was brightly hyperemic with curd. An ultrasound examination of the abdominal organs revealed changes in the liver in the form of increased sound conduction with depletion of the pattern. In a biochemical blood test, an increase in amylase activity to 96.1 U / L was noted; alkaline phosphatase up to 282 U / l, total cholesterol 6.77 mmol / l; LDL 3.9 Mmol / L; HDL 1.7 Mmol / L, ALT 42 U / L, ACT 40 U / L, triglycerides up to 1.8 mol / L. Clinically, there were complaints of pain in the area of the operation, poor tolerance of dairy products, flatulence, loose stool after each meal, general malaise, headaches, especially in a stuffy room, fatigue. Treatment was prescribed in accordance with the claimed method, according to which the physiotherapeutic factor is applied to the right hypochondrium and segments of the spinal cord. The impact is exerted by polarized light from a stationary apparatus "Bioptron-2" (Switzerland). The exposure is carried out by polarized polychromatic light containing various wavelengths in the range from 400 nm to 2000 nm (without ultraviolet radiation) at a power flux density of 40 mW / cm ² , light energy flux density per minute 2.4 J / cm ² , the light beam is sent to the right hypochondrium from a distance of 20 cm for 6 minutes, then a ray of light is sent to the area above the spinous processes of D6 - D10 vertebrae from a distance of 20 cm for 4 minutes. The exposure time for the procedure is 10 minutes, daily, for a course of 15 procedures. On the same day, an ophthalmic chromotherapy procedure is additionally performed. They are affected by blue light from the APEC apparatus with a wavelength of 430 ± 30 nm, a light pulse duration of 3.5-4 s, a pulse repetition rate of 9.2 ± 0.2 Hz for 10 minutes, daily, with a course of 15 procedures .

After the end of the course of treatment, positive dynamics were observed on fibrogastroscopy: the mucosa of the cardiac stomach is pale pink, the contents of the stomach are normal, there is no reflux of the duodenal contents, the mucous membrane of the stomach is pale pink, swelling is not noted, the mucosa of the duodenum is unchanged. In the biochemical parameters of blood normalization of indicators was noted: amylase activity up to 66 U / L (P <0.001); alkaline phosphatase up to 232 U / L (P <0.01), total cholesterol 5.7 Mmol / L; LDL 3.2 Mmol / L (P <0.01); HDL 1.1 Mmol / L (P <0.01), ALT 33 U / L (P <0.001); ACT 32 U / L (P <0.001); triglycerides up to 1.4 mol / L (P <0.01). Clinically, the patient did not show complaints, increased efficiency, normalized sleep. Discharged was in satisfactory condition.

Example No. 2. Patient S. born in 1973. Observation history No. 7. Received rehabilitation treatment on the 10th day after discharge from the surgical department with a diagnosis of the main: cholelithiasis, acute calculous cholecystitis, laparoscopic cholecystectomy; concomitant diagnosis: atrophic erosive gastritis. Sick for 4 years, when pain and heaviness in the epigastrium began to disturb, nausea associated with eating (especially oily and acute). In the last year, pain began to be paroxysmal acute. An ultrasound scan revealed gallbladder stones. In connection with the increase in paroxysmal pain, a planned operation was performed to remove the gallbladder by the endoscopic method. The postoperative period was uneventful and on the 6th day the patient was discharged from the department, and then he was admitted for early rehabilitation treatment at the Federal State Institution Central Administration of the Social Insurance Fund of the Russian Federation “Topaz”. A study was carried out of the state of the digestive system and blood serum indices before the course of treatment. During a fibrogastroscopic examination, the following changes were noted: the mucous membrane of the cardial stomach was hyperemic, there was mucus mixed with bile in the stomach, reflux of the duodenal contents into the stomach, the gastric mucosa was brightly hyperemic, the edematous, duodenal mucosa was brightly hyperemic with curd. An ultrasound examination of the abdominal organs showed changes in the liver in the form of an increase in its sound conductivity with a depletion of the pattern. In a biochemical blood test, an increase in amylase activity to 94.1 U / L was noted; alkaline phosphatase up to 288 U / l, total cholesterol 6.67 mmol / l; LDL 3.7 Mmol / L; HDL 1.6 Mmol / L, ALT 40 U / L, ACT 42 U / L, triglycerides up to 1.7 mol / L. Clinically, there were complaints of pain in the area of the operation, poor tolerance of dairy products, flatulence, loose stools after each meal, general malaise, headaches especially in a stuffy room, fatigue. Treatment was prescribed in accordance with the claimed method, according to which the physiotherapeutic factor is applied to the right hypochondrium and segments of the spinal cord. The impact is exerted by polarized light from a stationary apparatus "Bioptron-2" (Switzerland). The exposure is carried out by polarized polychromatic light containing various wavelengths in the range from 400 nm to 2000 nm (without ultraviolet radiation) at a power flux density of 40 mW / cm ² , light energy flux density per minute 2.4 J / cm ² , the light beam is sent to the right hypochondrium from a distance of 20 cm for 6 minutes, then a ray of light is sent to the area above the spinous processes D6 - D10 of the vertebrae from a distance of 20 cm for 4 minutes. The exposure time for the procedure is 10 minutes, daily, for a course of 15 procedures. Additionally, an ophthalmochromotherapy procedure is performed, blue eyes are exposed to the eyes from the APEC apparatus with a wavelength of 430 ± 30 nm, a light pulse duration of 3.5-4 s, a pulse repetition rate of 9.2 ± 0.2 Hz for 10 minutes, daily, course of 15 procedures.

After the end of the course of treatment, positive dynamics were observed on fibrogastroscopy: the mucosa of the cardiac stomach is pale pink, the contents of the stomach are normal, there is no reflux of the duodenal contents, the mucous membrane of the stomach is pale pink, swelling is not noted, the mucosa of the duodenum is unchanged. In the biochemical parameters of blood normalization of indicators was noted: amylase activity up to 65 U / L (P <0.001); alkaline phosphatase up to 230 U / l (P <0.01), total cholesterol 5.3 Mmol / l; LDL 3.0 Mmol / L (P <0.01); HDL 1.0 Mmol / L (P <0.01), ALT 30 U / L (P <0.001) ;, ACT 30 U / L (P <0.001); triglycerides up to 1.2 mol / L (P <0.01). Clinically, the patient did not complain, increased efficiency, normalized sleep. Discharged was in satisfactory condition.

Thus, the effect of the proposed method, consisting in the following:

- the disappearance of cholestatic manifestations (normalization of alkaline phosphatase, cholesterol);

- normalization of serum enzyme activity;

- normalization of fat metabolism;

- normalization of exocrine pancreatic function;

- elimination of duodenogastric reflux;

- normalization of the morphological picture of the gastric mucosa and duodenum;

- normalization of the clinical picture of the postresection period.

Table 1 Ultrasound indices of patients of the main and control groups before and after treatment Indicator Before treatment After treatment The main group (n = 24) Control Group (n = 21) The main group (n = 24) Control Group (n = 21) ECHOGENITY INCREASED INCREASED AVERAGE INCREASED SOUND CONDUCTIVITY REDUCED REDUCED SAVED REDUCED VASCULAR FIGURE UNLIMITED UNLIMITED NOT CHANGED UNLIMITED

table 2 Indicators of fibrogastroduodenoscopy of patients of the main and control groups before and after treatment Indicator Before treatment After treatment The main group (n = 24) Control Group (n = 21) The main group (n = 24) Control Group (n = 21) Cardiac Mucosa Hyperemic Hyperemic Pale pink Hyperemic Stomach contents Mucus mixed with bile Mucus mixed with bile Usual Mucus mixed with bile The presence of reflux of duodenal contents in the stomach Is available Is available Absent Is available The condition of the gastric mucosa Vividly hyperemic, swollen Vividly hyperemic, swollen Pale pink, no swelling Vividly hyperemic, swollen The condition of the mucosa of the duodenum 12 Cheesy plaque, hyperemia Cheesy plaque, hyperemia Not changed Hyperemia

Table 3 Biochemical parameters of patients of the main and control groups before and after treatment Indicator Before treatment After treatment Norm The main group (n = 24) Control Group (n = 21) The main group (n = 24) Control Group (n = 21) Total cholesterol 6.78 ± 0.9 6.80 ± 0.6 5.74 ± 0.81 6.0 ± 0.4 Up to 5.7 Mmol / l Mmol / l Mmol / l Mmol / l. Mmol / l P <0.01 P> 0.5 ALT M.47.6 ± 0.5 M.46.6 ± 0.2 M.37.6 ± 0.11 M.44.6 ± 0.12 M.40 / F.32 J. 43.2 ± 0.3 J. 44.2 ± 0.1 J. 33.2 ± 0.4 J. 43.2 ± 0.11 E / L E / L E / L E / L E / L P <0.01 P> 0.5 ACT M.46.9 ± 0.6 M.47.3 ± 0.5 M.38.1 ± 0.63 M.45.3 ± 0.25 M.38 / F.31 J. 40.7 ± 0.4 G.41.7 ± 0.1 J. 32.1 ± 0.1 J. 42.4 ± 0.12 E / L E / L E / L E / L E / L P <0.01 P> 0.5 Alpha amylase 96.7 ± 1.1 95.6 ± 1.5 66.3 ± 1.5 90.1 ± 0.4 Up to 90 U / L E / L E / L E / L E / L P <0.001 P> 0.5 HDL cholesterol 1.12 ± 0.03 1.12 ± 0.1 1.38 ± 0.02 1.15 ± 0.1 Not less than 1.4 mmol / l P <0.01 P> 0.5 LDL cholesterol 3.94 ± 0.02 3.98 ± 0.02 3.23 ± 0.01 3.94 ± 0.06 No more than 3,87 mmol / l P <0.01 P> 0.5 Triglycerides 1.78 ± 0.04 1.84 ± 0.1 1.54 ± 0.03 1.77 ± 0.07 Up to 1.7 mol / l P <0.01 P> 0.5

Claims (1)

A method of rehabilitation of patients with postcholecystectomy syndrome, including exposure to a physical factor on the area of surgical intervention, characterized in that the effect is started 10-12 days after surgery, as a physical factor, they are exposed to polychromatic polarized light from a Bioptron-2 stationary device containing various wavelengths in the range from 400 to 2000 nm with a power flux density of 40 mW / ^cm2 light energy flux density per minute of 2.4 J / cm ^2, the beam of light is directed into the right hypochondrium with races 20 cm for 6 min, then a light beam is directed to the area above the spinous processes of D6 - D10 vertebrae from a distance of 20 cm for 4 min, the exposure time for the procedure is 10 min, daily, in the course of 15 procedures, on the same day additionally affect eyes with blue light from the APEC apparatus with a wavelength of (430 ± 30) nm, a light pulse duration of 3.5-4 s, a pulse repetition rate of intra-pulse modulation (9.2 ± 0.2) Hz for 10 min, daily, in course 15 treatments.