Avtor/Urednik		Benedik, Tomaž
Naslov		Metode varne laparoskopske holecistektomije
Prevedeni naslov		Principles of safety in laparoscopic cholecystectomy
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 72, št. Suppl 1
Leto izdaje		2003
Obseg		str. I-3-7
Jezik		slo
Abstrakt		Background. After more than decade of routine use of laparoscopic cholecystectomy for treatment of symptomatic gallbladder stones, the incidence of biliary injuries, which are potentially life threatening and cause prolonged hospitalization and major morbidity, seems to be increased in laparoscopic cholecystectomy compared with open operation. Injury rate was from some reports 2.5 to 4 times higher than with open operation. There are many proposed classifications of types of biliary injuries. The most frequent direct causes of laparoscopic biliary injury are misidentification of the common bile duct, cautery injuries to the bile duct and improper application of clips to the cystic duct Conclusions. To avoid misidentification of ducts one should conclusively identify cystic duct and artery, the structures to be divide, in every laparoscopic cholecystectomy. To achieve that goal, Calotš triangle must be dissected free of fat and fibrous - tissue and the lower end of the gallbladder must be dissected of the liver bed. The only two structures entering the gallbladder should be visible - cystic duct and artery. With avoidance of blind application of cautery and clips to control bleeding one should avoid injury of bile duct Low cautery settings should be used in portal dissections to prevent arc. With meticulous care in dissection and conclusive identification of cystic duct and artery we can prevent injuries of bile duct, which still have impermissible high incidence. In the article 504 laparoscopic cholecystectomies performed at the Department of abdominal surgery in BPD in 2002 were analysed. We follow priciples of safety in laparoscopic cholecystectomy. There were no biliary injuries reports.
Izvleček		Izhodišča. Po več kot desetletni široki uporabi laparoskopske holecistektomije (LH) se še vedno soočamo s sorazmerno visoko pogostnosjo poškodb žolčevodov med LH, ki je po nekaterih podatkih 2,5- do 4-krat višja kot pri odprti holecistektomiji. Obširne analize vzrokov in dejavnikov tveganja za nastanek poškodb žolčevodov so opozorile na najpogostejšo napako, usodno za poškodbo: zamenjavo cističnega voda s skupnim jetrnim vodom, duktusom holedohusom ali aberantnim desnim jetrnim vodom. Zaključki. Da bi se izognili napačni prepoznavi žolčnih vodov, moramo pri vsaki LH nadvse skrbno in natančno identificirati anatomski strukturi, ki morata biti prekinjeni: to sta cistični vod in cistična arterija. Ti anatomski strukturi najustrezneje prikažemo z operativno metodo okna. Calotov trikotnik je potrebno odpreparirati od maščobnega tkiva in zarastlin ter fibroze, spodnji del žolčnika pa izluščiti iz jetrnega ležišča. Vidni sta lahko le dve anatomski strukturi, ki vstopata v žolčnik - cistični vod in cistična arterija. Pri delu v Calotovem trikotniku ne smemo uporabljati monopolarne elektrokoagulacije zaradi nevarnosti poškodb okolnih strukturz neposrednim termičnim delovanjem ali prek obločnega plamena. V letu 2002 smo na obeh kliničnih oddelkih za abdominalno kirurgijo (KOZAK) v Bolnišnici dr. Petra Držaja (BPD) napravili 773 operacij žolčnih kamnov, od tega 504 (65,2%) LH. Ob upoštevanju načel varne LH nismo zabeležili nobene poškodbe žolčevodov.
Deskriptorji		CHOLECYSTECTOMY, LAPAROSCOPIC INTRAOPERATIVE COMPLICATIONS BILE DUCTS CHOLELITHIASIS