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Функциональные расстройства желчного пузыря в практике терапевта
Функциональные расстройства желчного пузыря в практике терапевта
Мехтиев С.Н., Мехтиева О.А. Функциональные расстройства желчного пузыря в практике терапевта. Consilium Medicum. 2017; 19 (8.1. Гастроэнтерология): 35–41.
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Аннотация
В статье обсуждается проблема функциональных билиарных расстройств, в частности, функционального расстройства желчного пузыря: новые взгляды на этиопатогенетические механизмы развития данной патологии, современные клинические и лабораторно-инструментальные критерии диагностики, правила формулировки диагноза, подходы к медикаментозному и хирургическому лечению, предложена рабочая схема терапии и профилактики заболевания с позиции Римских критериев IV, принятых в 2016 г., и собственного клинического опыта.
Ключевые слова: функциональные билиарные расстройства, функциональное расстройство желчного пузыря, гимекромон, урсодезоксихолевая кислота, холецистэктомия.
Key words: functional biliary disorder, a functional disorder of the gallbladder, gimekromon, ursodeoxycholic acid, cholecystectomy.
Ключевые слова: функциональные билиарные расстройства, функциональное расстройство желчного пузыря, гимекромон, урсодезоксихолевая кислота, холецистэктомия.
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Key words: functional biliary disorder, a functional disorder of the gallbladder, gimekromon, ursodeoxycholic acid, cholecystectomy.
Полный текст
Список литературы
1. Ильченко А.А. Болезни желчного пузыря и желчных путей. Руководство для врачей. 2-е изд., перераб. и доп. М.: Медицинское информационное агентство, 2011. / Il'chenko A.A. Bolezni zhelchnogo puzyria i zhelchnykh putei. Rukovodstvo dlia vrachei. 2-e izd., pererab. i dop. M.: Meditsinskoe informatsionnoe agentstvo, 2011. [in Russian]
2. Amaral J, Xiao ZL, Chen Q et al. Gallbladder muscle dysfunction in patients with chronic acalculous disease. Gastroenterology 2001; 120: 506–11.
3. Лейшнер У. Практическое руководство по заболеваниям желчных путей. М.: ГЭОТАР-Медицина, 2001. / Leishner U. Prakticheskoe rukovodstvo po zabolevaniiam zhelchnykh putei. M.: GEOTAR-Meditsina, 2001. [in Russian]
4. Behar J, Corazziari E, Guelrud M et al. Functional Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2006; 130: 1498–509.
5. Bielefeldt K, Saligram S, Zickmund SL et al. Cholecystectomy for biliary dyskinesia: how did we get there? Dig Dis Sci 2014; 59: 2850–63.
6. Preston JF, Diggs BS, Dolan JP et al. Biliary dyskinesia: a surgical disease rarely found outside the United States. Am J Surg 2015; 209: 799–803.
7. Cotton PB, Elta GH, Carter CR et al. Rome IV. Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2016; pii: S0016–5085(16)00224–9.
8. Маев И.В., Вьючнова Е.С., Левченко О.Б. Дисфункция билиарного тракта: от патогенеза к выбору оптимальной терапии. РМЖ. 2011; 28: 1736–41. / Maev I.V., V'iuchnova E.S., Levchenko O.B. Disfunktsiia biliarnogo trakta: ot patogeneza k vyboru optimal'noi terapii. RMZh. 2011; 28: 1736–41. [in Russian]
9. Alcon S, Morales S, Camello PJ et al. Contribution of different phospholipases and arachidonic acid metabolites in the response of gallbladder smooth muscle to cholecystokinin. Biochem Pharmacol 2002; 64: 1157–67.
10. Lee YS, Kang BK, Hwang IK et al. Long-term Outcomes of Symptomatic Gallbladder Sludge. J Clin Gastroenterol 2015; 49 (7): 594–8.
11. Pozo MJ, Camello PJ, Mawe GM. Chemical mediators of gallbladder dysmotility. Curr Med Chem 2004; 11: 1801–12.
12. Sharma BC, Agarwal DK, Dhiman RK et al. Bile lithogenicity and gallbladder emptying in patients with microlithiasis: effect of bile acid therapy. Gastroenterology 1998; 115: 124–8.
13. Ozden N, DiBaise JK. Gallbladder ejection fraction and symptom outcome in patients with acalculous biliary-like pain. Dig Dis Sci 2003; 48: 890–7.
14. Delgado-Aros S, Cremonini F, Bredenoord AJ et al. Systematic review and meta-analysis: does gall-bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain? Aliment Pharmacol Ther 2003; 18: 167–74.
15. DiBaise JK, Richmond BK, Ziessman HA et al. Cholecystokinin-cholescintigraphy in adults: consensus recommendations of an interdisciplinary panel. Clin Nucl Med 2012; 37: 63–70.
16. Corwin MT, Lamba R, McGahan JP. Functional MR cholangiography of the cystic duct and sphincter of Oddi using gadoxetate disodium: is a 30-minute delay long enough? J Magn Reson Imaging 2013; 37: 993–8.
17. Fidler JL, Knudsen JM, Collins DA et al. Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain. AJR Am J Roentgenol 2013; 201: W271–W282.
18. Abate A, Dimartino V, Spina P et al. Hymecromone in the treatment of motor disorders of the bile ducts: a multicenter, double-blind, placebo-controlled clinical study. Drugs Exp Clin Res 2001; 27 (5–6): 223–31.
19. Garrett ER, Venitz J. Comparisons of detections, stabilities, and kinetics of degradation of hymecromone and its glucuronide and sulfate metabolites. J Pharm Sci 1994; 83 (1): 115–6.
20. Hoffmann RM, Schwarz G, Pohl C et al. Bile acid-independent effect of hymecromone on bile secretion and common bile duct motility. DMW 2005; 130 (34–35): 1938–43.
21. Hoult JR, Paya M. Pharmacological and biochemical actions of simple coumarins: natural products with therapeutic potential. Gen Pharmacol 1996; 27 (4): 713–22.
22. Najmanova I, Dosedel M, Hrdina R et al. Cardiovascular effects of coumarins besides their antioxidant activity. Curr Top Med Chem 2015; 15 (9): 830–49.
23. Насонова С.В., Цветкова Л.И. Опыт применения Одестона в лечении хронических заболеваний желчного пузыря и желчевыводящих путей. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2000; 3: 87–90. / Nasonova S.V., Tsvetkova L.I. Opyt primeneniia Odestona v lechenii khronicheskikh zabolevanii zhelchnogo puzyria i zhelchevyvodiashchikh putei. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2000; 3: 87–90. [in Russian]
24. Симаненков В.И. и др. Применение урсодезоксихолевой кислоты (Урдоксы) у пациентов с дискинезиями желчевыводящих путей. Методические рекомендации. СПб.: Фармпроект, 2010. / Simanenkov V.I. i dr. Primenenie ursodezoksikholevoi kisloty (Urdoksy) u patsientov s diskineziiami zhelchevyvodiashchikh putei. Metodicheskie rekomendatsii. SPb.: Farmproekt, 2010. [in Russian]
25. Goussous N, Kowdley GC, Sardana N et al. Gallbladder dysfunction: how much longer will it be controversial? Digestion 2014; 90 (3): 147–54.
26. Carr JA, Walls J, Bryan LJ et al. The treatment of gall- bladder dyskinesia based upon symptoms: results of a 2- year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech 2009; 19: 222–6.
27. Veenstra BR, Deal RA, Redondo RE et al. Long-term efficacy of laparoscopic cholecystectomy for the treatment of biliary dyskinesia. Am J Surg 2014; 207: 366–70.
2. Amaral J, Xiao ZL, Chen Q et al. Gallbladder muscle dysfunction in patients with chronic acalculous disease. Gastroenterology 2001; 120: 506–11.
3. Leishner U. Prakticheskoe rukovodstvo po zabolevaniiam zhelchnykh putei. M.: GEOTAR-Meditsina, 2001. [in Russian]
4. Behar J, Corazziari E, Guelrud M et al. Functional Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2006; 130: 1498–509.
5. Bielefeldt K, Saligram S, Zickmund SL et al. Cholecystectomy for biliary dyskinesia: how did we get there? Dig Dis Sci 2014; 59: 2850–63.
6. Preston JF, Diggs BS, Dolan JP et al. Biliary dyskinesia: a surgical disease rarely found outside the United States. Am J Surg 2015; 209: 799–803.
7. Cotton PB, Elta GH, Carter CR et al. Rome IV. Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2016; pii: S0016–5085(16)00224–9.
8. Maev I.V., V'iuchnova E.S., Levchenko O.B. Disfunktsiia biliarnogo trakta: ot patogeneza k vyboru optimal'noi terapii. RMZh. 2011; 28: 1736–41. [in Russian]
9. Alcon S, Morales S, Camello PJ et al. Contribution of different phospholipases and arachidonic acid metabolites in the response of gallbladder smooth muscle to cholecystokinin. Biochem Pharmacol 2002; 64: 1157–67.
10. Lee YS, Kang BK, Hwang IK et al. Long-term Outcomes of Symptomatic Gallbladder Sludge. J Clin Gastroenterol 2015; 49 (7): 594–8.
11. Pozo MJ, Camello PJ, Mawe GM. Chemical mediators of gallbladder dysmotility. Curr Med Chem 2004; 11: 1801–12.
12. Sharma BC, Agarwal DK, Dhiman RK et al. Bile lithogenicity and gallbladder emptying in patients with microlithiasis: effect of bile acid therapy. Gastroenterology 1998; 115: 124–8.
13. Ozden N, DiBaise JK. Gallbladder ejection fraction and symptom outcome in patients with acalculous biliary-like pain. Dig Dis Sci 2003; 48: 890–7.
14. Delgado-Aros S, Cremonini F, Bredenoord AJ et al. Systematic review and meta-analysis: does gall-bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain? Aliment Pharmacol Ther 2003; 18: 167–74.
15. DiBaise JK, Richmond BK, Ziessman HA et al. Cholecystokinin-cholescintigraphy in adults: consensus recommendations of an interdisciplinary panel. Clin Nucl Med 2012; 37: 63–70.
16. Corwin MT, Lamba R, McGahan JP. Functional MR cholangiography of the cystic duct and sphincter of Oddi using gadoxetate disodium: is a 30-minute delay long enough? J Magn Reson Imaging 2013; 37: 993–8.
17. Fidler JL, Knudsen JM, Collins DA et al. Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain. AJR Am J Roentgenol 2013; 201: W271–W282.
18. Abate A, Dimartino V, Spina P et al. Hymecromone in the treatment of motor disorders of the bile ducts: a multicenter, double-blind, placebo-controlled clinical study. Drugs Exp Clin Res 2001; 27 (5–6): 223–31.
19. Garrett ER, Venitz J. Comparisons of detections, stabilities, and kinetics of degradation of hymecromone and its glucuronide and sulfate metabolites. J Pharm Sci 1994; 83 (1): 115–6.
20. Hoffmann RM, Schwarz G, Pohl C et al. Bile acid-independent effect of hymecromone on bile secretion and common bile duct motility. DMW 2005; 130 (34–35): 1938–43.
21. Hoult JR, Paya M. Pharmacological and biochemical actions of simple coumarins: natural products with therapeutic potential. Gen Pharmacol 1996; 27 (4): 713–22.
22. Najmanova I, Dosedel M, Hrdina R et al. Cardiovascular effects of coumarins besides their antioxidant activity. Curr Top Med Chem 2015; 15 (9): 830–49.
23. Nasonova S.V., Tsvetkova L.I. Opyt primeneniia Odestona v lechenii khronicheskikh zabolevanii zhelchnogo puzyria i zhelchevyvodiashchikh putei. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2000; 3: 87–90. [in Russian]
24. Simanenkov V.I. i dr. Primenenie ursodezoksikholevoi kisloty (Urdoksy) u patsientov s diskineziiami zhelchevyvodiashchikh putei. Metodicheskie rekomendatsii. SPb.: Farmproekt, 2010. [in Russian]
25. Goussous N, Kowdley GC, Sardana N et al. Gallbladder dysfunction: how much longer will it be controversial? Digestion 2014; 90 (3): 147–54.
26. Carr JA, Walls J, Bryan LJ et al. The treatment of gall- bladder dyskinesia based upon symptoms: results of a 2- year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech 2009; 19: 222–6.
27. Veenstra BR, Deal RA, Redondo RE et al. Long-term efficacy of laparoscopic cholecystectomy for the treatment of biliary dyskinesia. Am J Surg 2014; 207: 366–70.
2. Amaral J, Xiao ZL, Chen Q et al. Gallbladder muscle dysfunction in patients with chronic acalculous disease. Gastroenterology 2001; 120: 506–11.
3. Лейшнер У. Практическое руководство по заболеваниям желчных путей. М.: ГЭОТАР-Медицина, 2001. / Leishner U. Prakticheskoe rukovodstvo po zabolevaniiam zhelchnykh putei. M.: GEOTAR-Meditsina, 2001. [in Russian]
4. Behar J, Corazziari E, Guelrud M et al. Functional Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2006; 130: 1498–509.
5. Bielefeldt K, Saligram S, Zickmund SL et al. Cholecystectomy for biliary dyskinesia: how did we get there? Dig Dis Sci 2014; 59: 2850–63.
6. Preston JF, Diggs BS, Dolan JP et al. Biliary dyskinesia: a surgical disease rarely found outside the United States. Am J Surg 2015; 209: 799–803.
7. Cotton PB, Elta GH, Carter CR et al. Rome IV. Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2016; pii: S0016–5085(16)00224–9.
8. Маев И.В., Вьючнова Е.С., Левченко О.Б. Дисфункция билиарного тракта: от патогенеза к выбору оптимальной терапии. РМЖ. 2011; 28: 1736–41. / Maev I.V., V'iuchnova E.S., Levchenko O.B. Disfunktsiia biliarnogo trakta: ot patogeneza k vyboru optimal'noi terapii. RMZh. 2011; 28: 1736–41. [in Russian]
9. Alcon S, Morales S, Camello PJ et al. Contribution of different phospholipases and arachidonic acid metabolites in the response of gallbladder smooth muscle to cholecystokinin. Biochem Pharmacol 2002; 64: 1157–67.
10. Lee YS, Kang BK, Hwang IK et al. Long-term Outcomes of Symptomatic Gallbladder Sludge. J Clin Gastroenterol 2015; 49 (7): 594–8.
11. Pozo MJ, Camello PJ, Mawe GM. Chemical mediators of gallbladder dysmotility. Curr Med Chem 2004; 11: 1801–12.
12. Sharma BC, Agarwal DK, Dhiman RK et al. Bile lithogenicity and gallbladder emptying in patients with microlithiasis: effect of bile acid therapy. Gastroenterology 1998; 115: 124–8.
13. Ozden N, DiBaise JK. Gallbladder ejection fraction and symptom outcome in patients with acalculous biliary-like pain. Dig Dis Sci 2003; 48: 890–7.
14. Delgado-Aros S, Cremonini F, Bredenoord AJ et al. Systematic review and meta-analysis: does gall-bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain? Aliment Pharmacol Ther 2003; 18: 167–74.
15. DiBaise JK, Richmond BK, Ziessman HA et al. Cholecystokinin-cholescintigraphy in adults: consensus recommendations of an interdisciplinary panel. Clin Nucl Med 2012; 37: 63–70.
16. Corwin MT, Lamba R, McGahan JP. Functional MR cholangiography of the cystic duct and sphincter of Oddi using gadoxetate disodium: is a 30-minute delay long enough? J Magn Reson Imaging 2013; 37: 993–8.
17. Fidler JL, Knudsen JM, Collins DA et al. Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain. AJR Am J Roentgenol 2013; 201: W271–W282.
18. Abate A, Dimartino V, Spina P et al. Hymecromone in the treatment of motor disorders of the bile ducts: a multicenter, double-blind, placebo-controlled clinical study. Drugs Exp Clin Res 2001; 27 (5–6): 223–31.
19. Garrett ER, Venitz J. Comparisons of detections, stabilities, and kinetics of degradation of hymecromone and its glucuronide and sulfate metabolites. J Pharm Sci 1994; 83 (1): 115–6.
20. Hoffmann RM, Schwarz G, Pohl C et al. Bile acid-independent effect of hymecromone on bile secretion and common bile duct motility. DMW 2005; 130 (34–35): 1938–43.
21. Hoult JR, Paya M. Pharmacological and biochemical actions of simple coumarins: natural products with therapeutic potential. Gen Pharmacol 1996; 27 (4): 713–22.
22. Najmanova I, Dosedel M, Hrdina R et al. Cardiovascular effects of coumarins besides their antioxidant activity. Curr Top Med Chem 2015; 15 (9): 830–49.
23. Насонова С.В., Цветкова Л.И. Опыт применения Одестона в лечении хронических заболеваний желчного пузыря и желчевыводящих путей. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2000; 3: 87–90. / Nasonova S.V., Tsvetkova L.I. Opyt primeneniia Odestona v lechenii khronicheskikh zabolevanii zhelchnogo puzyria i zhelchevyvodiashchikh putei. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2000; 3: 87–90. [in Russian]
24. Симаненков В.И. и др. Применение урсодезоксихолевой кислоты (Урдоксы) у пациентов с дискинезиями желчевыводящих путей. Методические рекомендации. СПб.: Фармпроект, 2010. / Simanenkov V.I. i dr. Primenenie ursodezoksikholevoi kisloty (Urdoksy) u patsientov s diskineziiami zhelchevyvodiashchikh putei. Metodicheskie rekomendatsii. SPb.: Farmproekt, 2010. [in Russian]
25. Goussous N, Kowdley GC, Sardana N et al. Gallbladder dysfunction: how much longer will it be controversial? Digestion 2014; 90 (3): 147–54.
26. Carr JA, Walls J, Bryan LJ et al. The treatment of gall- bladder dyskinesia based upon symptoms: results of a 2- year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech 2009; 19: 222–6.
27. Veenstra BR, Deal RA, Redondo RE et al. Long-term efficacy of laparoscopic cholecystectomy for the treatment of biliary dyskinesia. Am J Surg 2014; 207: 366–70.
________________________________________________
2. Amaral J, Xiao ZL, Chen Q et al. Gallbladder muscle dysfunction in patients with chronic acalculous disease. Gastroenterology 2001; 120: 506–11.
3. Leishner U. Prakticheskoe rukovodstvo po zabolevaniiam zhelchnykh putei. M.: GEOTAR-Meditsina, 2001. [in Russian]
4. Behar J, Corazziari E, Guelrud M et al. Functional Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2006; 130: 1498–509.
5. Bielefeldt K, Saligram S, Zickmund SL et al. Cholecystectomy for biliary dyskinesia: how did we get there? Dig Dis Sci 2014; 59: 2850–63.
6. Preston JF, Diggs BS, Dolan JP et al. Biliary dyskinesia: a surgical disease rarely found outside the United States. Am J Surg 2015; 209: 799–803.
7. Cotton PB, Elta GH, Carter CR et al. Rome IV. Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2016; pii: S0016–5085(16)00224–9.
8. Maev I.V., V'iuchnova E.S., Levchenko O.B. Disfunktsiia biliarnogo trakta: ot patogeneza k vyboru optimal'noi terapii. RMZh. 2011; 28: 1736–41. [in Russian]
9. Alcon S, Morales S, Camello PJ et al. Contribution of different phospholipases and arachidonic acid metabolites in the response of gallbladder smooth muscle to cholecystokinin. Biochem Pharmacol 2002; 64: 1157–67.
10. Lee YS, Kang BK, Hwang IK et al. Long-term Outcomes of Symptomatic Gallbladder Sludge. J Clin Gastroenterol 2015; 49 (7): 594–8.
11. Pozo MJ, Camello PJ, Mawe GM. Chemical mediators of gallbladder dysmotility. Curr Med Chem 2004; 11: 1801–12.
12. Sharma BC, Agarwal DK, Dhiman RK et al. Bile lithogenicity and gallbladder emptying in patients with microlithiasis: effect of bile acid therapy. Gastroenterology 1998; 115: 124–8.
13. Ozden N, DiBaise JK. Gallbladder ejection fraction and symptom outcome in patients with acalculous biliary-like pain. Dig Dis Sci 2003; 48: 890–7.
14. Delgado-Aros S, Cremonini F, Bredenoord AJ et al. Systematic review and meta-analysis: does gall-bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain? Aliment Pharmacol Ther 2003; 18: 167–74.
15. DiBaise JK, Richmond BK, Ziessman HA et al. Cholecystokinin-cholescintigraphy in adults: consensus recommendations of an interdisciplinary panel. Clin Nucl Med 2012; 37: 63–70.
16. Corwin MT, Lamba R, McGahan JP. Functional MR cholangiography of the cystic duct and sphincter of Oddi using gadoxetate disodium: is a 30-minute delay long enough? J Magn Reson Imaging 2013; 37: 993–8.
17. Fidler JL, Knudsen JM, Collins DA et al. Prospective assessment of dynamic CT and MR cholangiography in functional biliary pain. AJR Am J Roentgenol 2013; 201: W271–W282.
18. Abate A, Dimartino V, Spina P et al. Hymecromone in the treatment of motor disorders of the bile ducts: a multicenter, double-blind, placebo-controlled clinical study. Drugs Exp Clin Res 2001; 27 (5–6): 223–31.
19. Garrett ER, Venitz J. Comparisons of detections, stabilities, and kinetics of degradation of hymecromone and its glucuronide and sulfate metabolites. J Pharm Sci 1994; 83 (1): 115–6.
20. Hoffmann RM, Schwarz G, Pohl C et al. Bile acid-independent effect of hymecromone on bile secretion and common bile duct motility. DMW 2005; 130 (34–35): 1938–43.
21. Hoult JR, Paya M. Pharmacological and biochemical actions of simple coumarins: natural products with therapeutic potential. Gen Pharmacol 1996; 27 (4): 713–22.
22. Najmanova I, Dosedel M, Hrdina R et al. Cardiovascular effects of coumarins besides their antioxidant activity. Curr Top Med Chem 2015; 15 (9): 830–49.
23. Nasonova S.V., Tsvetkova L.I. Opyt primeneniia Odestona v lechenii khronicheskikh zabolevanii zhelchnogo puzyria i zhelchevyvodiashchikh putei. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2000; 3: 87–90. [in Russian]
24. Simanenkov V.I. i dr. Primenenie ursodezoksikholevoi kisloty (Urdoksy) u patsientov s diskineziiami zhelchevyvodiashchikh putei. Metodicheskie rekomendatsii. SPb.: Farmproekt, 2010. [in Russian]
25. Goussous N, Kowdley GC, Sardana N et al. Gallbladder dysfunction: how much longer will it be controversial? Digestion 2014; 90 (3): 147–54.
26. Carr JA, Walls J, Bryan LJ et al. The treatment of gall- bladder dyskinesia based upon symptoms: results of a 2- year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech 2009; 19: 222–6.
27. Veenstra BR, Deal RA, Redondo RE et al. Long-term efficacy of laparoscopic cholecystectomy for the treatment of biliary dyskinesia. Am J Surg 2014; 207: 366–70.
Авторы
С.Н.Мехтиев*, О.А.Мехтиева
ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова» Минздрава России. 197022, Россия, Санкт-Петербург, ул. Льва Толстого, д. 6/8
*sabirm@mail.ru
I.M.Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation. 197022, Russian Federation, Saint Petersburg, ul. L’va Tolstogo, d. 6/8
*sabirm@mail.ru
ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова» Минздрава России. 197022, Россия, Санкт-Петербург, ул. Льва Толстого, д. 6/8
*sabirm@mail.ru
________________________________________________
I.M.Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation. 197022, Russian Federation, Saint Petersburg, ul. L’va Tolstogo, d. 6/8
*sabirm@mail.ru
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