Avtor/Urednik     Vračko, Jože
Naslov     Laparoskopski transcistični pregled žolčevodov in odstranjevanje žolčevodnih kamnov
Prevedeni naslov     Laparoscopic transcystic common bile duct exploration and bile duct stones extraction
Tip     članek
Vir     Endoskopska revija
Vol. in št.     Letnik 3, št. 6
Leto izdaje     1998
Obseg     str. 67-74
Jezik     slo
Abstrakt     Background. Laparoscopic transcystic (L-TC) common bile ducts exploration with a simultaneous removal of common duct stones has been recognized worldwide as a standard technique for treating patients with gallstones and common bile duct calculi. The procedure is more easy to perform by the transcystic approach than via laparoscopic choledochotomy. The latter requires closure by the T-tube drainage and is associated with longer hospital stay. The paper present L-TC choledochoscopy and estraction of common duct stones performed in our patients. Patients and methods. The series included 13 female and 5 male patients, aged 53 to 72 years (mean age 64 yrs). A flexible scope, either 5 mm or 2.4 mm in diameter, was inerted via the cystic duct into the biliary ducts. indications for the procedure included suspected and unsuspected choledocholithiasis, and mild-degree of acute bilitary pancreatitis. L-TC cholangiography was used selectively. Very small common duct concrements, and tiny stone fragments and gravel were washed out and/or pushed throught the papilla of Vater into the duodenum, while larger calculi were extracted via the cystic duct with a Dormia basket. Results. The endoscope was successfully inserted into the biliary ducts in 13 of the 18 patients. The feasibility rate of L-TC choledochoscopy was 72%, and the success rate for removal of common duct stones 87.5%. Five patients harbouring very small gallstones had severe inflammation of the distal end of the main bile duct. Inour series there were no intraoperative or postoperative complications. The lenght of postoperative hospital stay was 2 to 5 days (mean 3 days).(Abstract truncated at 2000 characters)
Izvleček     Laparoskopski transcistični (L-TC) pregled žolčevodov in odstranjevanje žolčevodnih kamnov je v svetu uveljavljen postopek pri zdravljenju bolnikov s kamni v žolčniku in žolčevodih. Je lažje izvedljiv kot skozi laparoskopsko holedohotomijo, saj moramo le-to laparoskopsko zapreti prek drena T, podaljša pa se tudi pooperativna hospitalizacija. Članek obravnava postopke in rezultate L-TC holedohoskopij in odstranjevanja žolčnih kamnov pri naših bolnikih. Bolniki in metode. V obravnavani skupini je bilo 13 bolnic in 5 bolnikov, starih od 53 do 72 let, povprečno 64 let, pri katerih smo uporabili gibljiv holedohoskop večjega (5 mm) ali manjšega (2,4 mm) premera, ki smo ga skozi cistični vod uvedli v žolčna izvodila. Za poseg smo se odločili pri bolnikih s pričakovano ali nepričakovano holedohilitiazo in pri tistih z blago izraženim akutnim biliarnim pankreatitisom. L-TC holangiografijo smo izvajali selektivno. Drobne žolčevode kamne, mulj in drobir smo z izpiranjem odplavili in/ali potisnili skozi papilo Vateri v dvanajstnik, večje kamne pa smo s košarico Dormia odstranili skozi cistični vod. Rezultati. Pri 13 bolnikih od 18 smo holedohoskop uspešno uvedli v žolčna izvodila. izvedljivost L-TC holedohoskopij je bila 72%, uspešnost odstranjevanja žolčevodnih kamov 87,5%. Pri petih bolnikih z drobnimi žolčnimi kamni je bil močno izražen holangitis v končnem delu glavnega žolčevoda. Operativnih in pooperativnih zapletov ni bilo, pooperativna hospitalizacija je bila od 2-5 dni, povprečno tri dni. Zaključki. Z L-TC pregledom žolčevodov in odstranjevanjem žolčevodnih kamnov skozi cistični vod, z njihovim odplavljanjem ali potiskanjem skozi papilo Vateri v dvanajstnik, lahko sedaj tudi naše bolnike s kamni v žolčniku in žolčevodih zdravimo samo z laparoskopskim posegom.(Izvleček prekinjen pri 2000 znakih)
Deskriptorji     CHOLELITHIASIS
CHOLECYSTECTOMY, LAPAROSCOPIC
CHOLEDOCHOSTOMY
COMMON BILE DUCT CALCULI
PANCREATITIS