Avtor/Urednik     Vračko, Jože
Naslov     Sodobna obravnava bolnikov z laparoskopskimi poškodbami žolčevodov, zaznanimi med holecistektomijo
Prevedeni naslov     Modern therapeutic approaches to laparoscopic bile duct injuries indentified during cholecystectomy
Tip     članek
Vir     Endoskopska revija
Vol. in št.     Letnik 1, št. 2
Leto izdaje     1996
Obseg     str. 73-8
Jezik     slo
Abstrakt     Backgraund. Both classical and laparoscopic holecystectomies may be associated with bile duct injuries, yet the latter are only rarely apparent at the time of surgery. Once the injury is identified, the operating surgeon should decide which of the available surgical procedures to use. Patients, methods, results. The highest success rates have been observed with the primary repair of bile duct injuries. The laparoscopic sergeon may choose, depending on the type and extent of injury, and his skill and experience, between immediate primary repair, on the one hand, and drainage of injured bile ducts and the subhepatic space, and referral to a biliary specialist, on the other. Despite the interval between injury and surgery, referring patients for the first repair of bile duct injuries to speciality surgeons has been documented to have good chance for a successful result. Yet, considering the data on the incidence of laparoscopic bile duct injuries, successful repairs seem also to be provided in non-specialist institutions. Since blood supply to the bile ducts cannot be foreseen, these injuries are only rarely amenable to an end-to-end anastomosis. Constriction of a Roux-en-Y biliary-enteric anastomosis is the method of choice, though this type of anastomosis also tends to cause late strictures. Conclusions. Prevention of laparoscopic bile duct injuries should remain our primary goal despite the high success rate of repairs done by biliary specialists and other surgeons. Appropriate visualization and meticulous exposure of anatomic structures in the triangle of Calot are imperative. Division of these structures, without the use of electrocountery, is done only after the gallbladder infundibulum has been safely separated from the liver bed, thereby ensuring that solely the ducts leading to the gallbladder will be divided.
Izvleček     Izhodišča. Tako kot smo se pri klasični, se tudi pri laparoskopski holecistektomiji soočamo s poškodbami žolčevodov, ki pa so med operativnim posegom redko zazavne. Pri teh se lahko kirurg odloči za različne nadaljnje kirurške postopke. Bolniki, metode in rezultati. Dosedanje izkušnje so pokazale, da so rezultati primarnih rekonstrukcij žolčevodov najboljši. Glede na obliko in obseg poškodbe ter izkušenj se kirurg lahko odloči za njihovo takojšnjo, primarno rekonstrukcijo, ali pa poškodovane žolčevode ter subhepatični prostor drenira in premesti bolnika v ustanovo, specializirano za biliarno kirurgijo. V teh so, kljub krajšemu časovnemu presledku po poškodbi, rezultati primarnih rekonstrukcij dokumentirano dobri. Glede na podatke o pogostnosti tovrstnih poškodb pa so rekonstrukcije nedvomno uspešne tudi zunaj teh ustanov. Ker prekrvavitve žolčevodov ni možno predvideti, je anastomoza konec s koncem le redko primarna. Najboljša je biliarno-enterična anastomoza po Rouxu, ki pa se sčasoma tudi oži. Zaključki. Ne glede na uspešnost rekonstruktivnih posegov laparoskopskih poškodb žolčevodov v specializiranih ustanovah in drugje, je najbolj umestno njihovo preprečevanje. Preprečimo jih z natančnim prepariranjem anatomskih struktur v Calotovem trikotniku. Prekinemo jih brez uporabe kutorja šele po odprepariranju infundibuluma žolčnika iz ležišča jeter. Le tako bomo prekinili zgolj tiste, ki vodijo v žolčnik.
Deskriptorji     CHOLECYSTECTOMY, LAPAROSCOPIC
BILE DUCTS
IATROGENIC DISEASE
SLOVENIA