EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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In the period from September, 2003 to October, 2006 we observed 56 patients treated with laparoscopic cholecystectomy for gallstone disease at the surgical department Nr. 1 of A. Novak Transcarpathian Regional Clinical Hospital. Thirty-eight patients underwent post-operative rehabilitation at “Polyana” sanatorium.

The majority of the patients (92%) were transferred to the sanatorium “Polyana” within 1-2 weeks after surgery whereas, 8% were admitted later – within 2-4 weeks. Patient ages were between 18 and 78 years with an average of 42.0±2.0 years. Women of working age comprised 88% of the group. Comorbidities included chronic pancreatitis in 24%, large bowel dyskinesia in 36% and chronic hepatitis in 29% of cases.

In spite of numerous publications in the surgical literature the problem of gallstone disease remains unresolved. Introduction of minimally invasive methods of surgical treatment for gallstone disease such as of laparoscopic cholecystectomy led to significant reductions in intra-operative trauma and post-operative complications. If further improvements in management of gallstone disease are searched for, however, investigation of the role perturbations in local and humoral immunity caused by gallstone disease needs to be carried out. Furthermore, optimization of post-surgery rehabilitation would be desirable.

Investigations, which were carried out, let us determine, that we can see a number of changes in the early period after laparoscopic cholecystectomy in the liver and in the biliary system of patients with gallstone disease. It is shown both clinically and by analyzing laboratorial indices, which characterizes the functional state of liver and the immune system. Mesenchymal syndrome, cytological syndrome, reduction of synthetic processes in the liver, abnormalities in pigmentary and lipid exchange were noticed more then in half of cases.

The biochemical indices of patients’ blood serum in the early post-operative period and after rehabilitation in the “Polyana” sanatorium (M+m)

*-differences have been compared with indices of healthy people and are reliable (p<0.05)

While investigating the immune status of patients in a short space of time after laparoscopic cholecystectomy, activation of humoral immunity, activation of autoimmune reaction (antibody titer rising to the tissue antigens of liver, rising of circulating immune complex’s level) and reduction of nonspecific resistance indices have been noticed.

The prescription of rehabilitation with the use of mineral water “Polyana Kupely” for the patients in short period after laparoscopic cholecystectomy led to the decreasing of clinical symptoms of the disease (disappearance of asthenic syndrome, dyspeptic syndrome in 80% of patients and liver downsizing), and also to the improvement of indices, which characterizes the functional status of liver and immune system. The activity of indicator enzymes (alanine aminotransferase and aspartatamino-transferaza) was reduced during the process of medical treatment; the level of bilirubin and lipids in blood was normalized. In the same time the symptoms of mesenchymal syndrome (rising of γ-globulins, thymol test) and cytological syndrome were present. In cases of patients treated via laparascopic cholecystectomy for gallstone disease who underwent rehabilitation in sanatorium “Polyana”, the improvement of tissue and humoral immunity was noticed; the indices of E-RUK (p<0.012), alexine (p<0.09), titre general IgE-AT (p<0.1), antigens to the pancreas (p<0.03), ceruloplasmin (p<0.09) were rising. Our observations have shown that the best effect of early (within 1-2 weeks after surgery) rehabilitation in sanatorium “Polyana” occurs in cases of patients with not complicated gallstone disease who underwent routine surgery with a short presurgical period. The majority of these have considerable improving of general condition, normalization of the indices of functional state of liver and of the immunoresponsiveness of the organism.