Avtor/Urednik		Mahne, Stanislav; Jelačin, Tomaž; Mioč, Jakov; Guzej, Žare; Jakomin, Milan
Naslov		Poškodbe žolčevodov pri laparoskopski in klasični holecistektomiji
Prevedeni naslov		Bile duct injuries during laparoscopic and open cholecystectomy
Tip		članek
Vir		Endoskopska revija
Vol. in št.		Letnik 4, št. 10
Leto izdaje		1999
Obseg		str. 173-8
Jezik		slo
Abstrakt		Background. Along with the widespread use of laparoscopic cholecystectomy (LC), increased rates of bile duct injuries have been reported by many authors. Patients and methods. From June 1992, when LC was introduced at this institution, to June 1999, we performed 1,916 cholecystectomies, of which 1,061 LCs (55%) with a conversion rate of 4,5%, and 855 (45%) open cholecystectomies. Intraoperative cholangiography was invariably performed during open cholecystectomy, but only rarely during LC. The paper reports only major bile ducts injuries. Cases of prolonged biliary secretion or subhepatic bile collection, where bile duct injury was not confirmed, were not included in the analysis. Results. During the period studied, 7 major bile duct injuries (0.37%) were documented in the overall series. Four injuries occurred during LC (0.38% of all LCs): one was diagnosed during the primary operation and the other three in the immediate postoperative period. One lesion was managed during the first operation and three at re-operation. Further course was favourable for all four patients. Open cholecystectomy was associated with 3 major bile duct injuries (0.35%). One lesion was treated during the primary operation, while 2 where detected and managed in the early postoperative course. Two of these patients died 2 and 4 weeks after the operation, respectively. Conclusions. The rate of bile duct duct injuries in our series was nearly the same for LC and open cholecystectomy, and did not exceed the figures reported in the literature. Five of the 7 bile duct injuries were detected only after the primary operation. The increased incidence of these injuries occurring during LC may be due to the lack of experience and the learning curve in the initial period. The paper stresses the importance of preventing these dangerous complications both during LC and open cholecystectomy.
Izvleček		Izhodišča. Po široki uveljavitvi laparoskopske holecistektomije (LH) številni avtorji poročajo o povečanem številu poškodb žolčevodov. Bolniki in metode. V sedmiih letih, od junija 1992 do junija 1999, smo opravili 1916 holecistektomij: 1061 (55%) laparoskopskih in 855 (45%) klasičnih. Stopnja konverzije pri LH je bila 4,5%. V prispevku obravnavamo le težje poškodbe žolčevodov; niso všteti primeri podaljšane žolčne sekrecije ali subhepatalne kolekcije žolča, kjer poškodba žolčevoda ni bila potrjena. Rezultati. Ugotovili smo 7 težjih poškodb žolčevodov, kar pomeni 0,37% v celotni seriji. 4 poškodbe so nstale pri LH (0,38% od vseh LH). Ena od teh je bila ugotovljena med operacijo, preostale tri pa v zgodnjem pooperativnem obdobju. Poškodba žolčevoda je bila pri enem bolniku oskrbljena pri prvi operaciji, preostali trije pa so bili ponovno operirani. Pri vseh je bil nadaljnji potek doslej ugoden. Pri klasični holecistektomiji smo imeli tri hujše poškodbe (0,35%); ena je bila odkrita med prvo operacijo in dve v zgodnjem pooperativnem poteku. Pri prvem je bila poškodba oskrbljena že pri prvi operaciji, druga dva bolnika pa sta bila ponobno operirana. Pri enem bolniku je doslej potek ugoden, dva pa sta umrla (dva tedna oziroma štiri tedne po posegu). Zaključek. V naši seriji so poškodbe žolčevodov praktično enako pogoste pri LH kot pri klasižni holecistektomiji. Pogostnost omenjenih poškodb ne odstopa od večine objavljenih serij. Od sedmih primerov sta bila samo dva odkrita med prvo operacijo, preostalih pet pa je bilo odkritih kasneje. Večje število poškodb žolčevodov pri LH je bilo morda posledica neizkušenosti in učne dobe v prvih letih uvajanja LH. Menimo, da je potrebno poudariti skrb za preventivo teh nevarnih poškodb tako pri LH kot pri klasični holecistektomiji.
Deskriptorji		CHOLECYSTECTOMY CHOLECYSTECTOMY, LAPAROSCOPIC BILE DUCTS CHOLANGIOGRAPHY INTRAOPERATIVE PERIOD