Avtor/Urednik		Vračko, Jože
Naslov		Ductus cysticus - naravni vhod za holedoholitotripsijo med laparoskopsko holecistektomijo
Prevedeni naslov		The cystic duct - the natural access for choledocholithotripsy during laparoscopic cholecystectomy
Tip		članek
Vir		Endoskopska revija
Vol. in št.		Letnik 4, št. 9
Leto izdaje		1999
Obseg		str. 93-8
Jezik		slo
Abstrakt		For 10 years, the management of patients with biliary calculi was conducted in two stages comprising laparoscopy and endoscopy. At present, however, one-stage procedures for laparoscopic extraction of common bile duct stones are available. In most patients, the calculi have migrated to the common bile duct from the gall bladder through the cystic duct. Therefore it seems logical to remove them by the same route. In patients harbouring common bile duct stones, the luminal diameter of the patients, the diameter of the largest stone found in the common bile duct is smaller than or equal to the luminal diameter of the corresponding cystic duct, which dilates further when Heister's valves are divided. Thanks to these favourable anatomical circumstance, the success rate of trans-cystic common bile duct stone extraction can be as high as 98%. If the trans-cystic approach fails, laparoscopic choledochotoomy with T-drain placement, classical choledocholithotripsy or postoperative endoscopic papillotomy can be undertaken. The modern one-stage method for common bile duct stone extraction via the cystic duct, representing the natural access to the common bile duct, is undoubtedly justified on ethical and economic grounds.
Izvleček		Po desetletnem obdobju dvostopenjskega - laparoskopskega in endoskopskega - zdravljenja bolnikov s kamni v žolčniku in žolčevodih so odslej na voljo postopki za enostopenjsko laparoskopsko zdravljenje bolnikov s holedoholitiazo. Ker so pri večini bolnikov kamni potovali iz žolčnika v žolčevode skozi duktus cistikus je razumljivo, da jih odstranjujemo po isti poti. Pri bolnikih s holedoholitiazo je namreč premer cističnega voda večji kot pri bolnikih s simptomatsko holecistolitiazo. Poleg tega so pri 3/4 bolnikov največji kamni v žolčevodih manjši ali enakega premera kot je premer svetline pripadajočega cističnega voda, ki se po prekinitvi Heisterjevih zaklopk še bolj razširi. te ugodne anatomske razmere omogočajo tudi do 89-odstotno usepšnost transcističnega odstranjevanja žolčevodnih kamnov. Kolikor transcistični pristop ne uspe, se lahko odločimo za laparoskopsko holedohotomijo z namestitvijo drena T, za klasično holedoholitotripsijo ali pa za pooperativno endoskopsko papilotomijo. Sodobno laparoskopsko odstranjevanje žolčevodnih kamnov skozi cistični vod, ki je naravni vhod v žolčevode, je nedvomno etično in ekonomsko utemeljeno, saj bolnike ozdravimo samo z enim posegom.
Deskriptorji		CYSTIC DUCT CHOLECYSTECTOMY, LAPAROSCOPIC COMMON BILE DUCT CALCULI TREATMENT OUTCOME SLOVENIA SURGERY, ENDOSCOPIC