Author/Editor		Vračko, Jože
Title		Sodobno zdravljenje bolnikov s simptomatsko holecistolitiazo in holedoholitiazo je - laparoskopsko
Translated title		The modern treatment of patients with symptomatic gallbladder and common bile duct stones is laparoscopical
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 9, št. 22
Publication year		2004
Volume		str. 19-25
Language		slo
Abstract		The paper deals with different approaches to the treatment of patients with gallstones and common bile duct calculi. Laparoscopic cholecystectomy, extended to involve common bile duct exploration, is the most "patient friendly" technigue available. Since endoscopic and conventional choledocholithotripsy are still in use today, preoperatively suspected common bile duct stones can be safely extracted by preoperative endoscopic papillectomy, followed by laparoscopic cholecystectomy. The results of endoscopy must always be verified cholangiographically. If the endoscopic procedure is unsuccessful, either open choledochotomy or postoperative endoscopic extraction of retained calculi is accomplished. In patients with unsuspected choledocholithiasis, discovered by laparoscopic cholangiography or by ultrasound during cholecystectomy, the management is either conversion to conventional biliary duct exploration, or postoperative extraction of common bile duct calculi, using endoscopic papillectomy. The latter technique, however, does not always prove succcessful. The modern treatment of patients with cholelithiasis and choledocholithiasis is a single-stage laparoscopic cholecystectomy combined with transcystic bile duct exploration, or laparoscopic choledochotomy. The advantage conferred by laparoscopic extraction of gall stones and common bile duct stones is that it preserves the function of the sphincter of Oddi that regulates the flow of bile and pancreatic juice into the duodenum, and thereby prevents reflux of duodenal contents into the biliary tree. Laparoscopic management has been therefore recognized as the gold standard , for treating patients with cholelithiasis and choledocholithiasis.
Summary		V članku obravnavam različne postopke pri zdravljenju bolnikov s kamni v žolčniku in žolčevodih od katerih je za bolnika najugodnejša laparoskopska holecistektomija, rarširjena na eksplorucijo žolčevodov. Kljub temu so v sedanjem času v veljavi še endoskopska in klasična holedoholitotripsija zato lahko pri bolnikih s predoperativno pričakovano holedoholitiazo kamne iz žolčevodov odstranimo s pomočjo predoperativne endoskopske papilotomije, ki ji sledi laparoakopska holecistektomija, pri kateri moramo s holangiografijo preveriti uspešnost endoskopskega posega. Če ta ni uspel, se odločimo za klasično holedohotomijo ali za pooperativno endoskopsko ekstrakcijo zaostalih kamnov. Pri bolnikih z nepričakovano holedoholitiazo, ki jo z laparoskopsko holangiografijo ali sonografijo ugotovimo med holecistektomijo, se lahko odločimo za preklop v klasično eksploracijo žolčevodov ali pa za pooperativno odstranitev žolčevodnih kamnov s pomočjo endoskopske papilotomije, ki pa ni vedno uspešna. Sodobno zdravimo bolnike s kamni v žolčniku in žolčevodih z laparoskopsko holecistektomijo, ki je razširimo na eksploracijo žolčevodov skozi cistični vod ali z Iaparoskopsko holedohotomijo. S tem bolnike ozdravimo samo z enim posegom. Pregled objavljenih rezultatov potrjuje uspešnost laparoskopskega zdravljenja bolnikov s kamni v žolčniku in žolčevodih, ki je primerljivo s klasičnim ali endoskopskim zdravljenjem. Predvsem pa je z laparoskopskim zdravljenjem bolnikov s holecistolitiazo in holedoholitiazo ohranjena funkcija Oddijevega sfinktra, ki uravnava pretok žolča in pankreatičnega soka v dvanajstnik in preprečuje zatekanje duodenalne vsebine v žolčna izvodila. Zato je laparoskopska obravnava bolnikov s holelitiazo in holedoholitiazo najprimernejša in sodobna.
Descriptors		CHOLANGIOPANCREATOGRAPHY, ENDOSCOPIC RETROGRADE SPHINCTEROTOMY, ENDOSCOPIC CHOLELITHIASIS COMMON BILE DUCT CALCULI CHOLECYSTECTOMY, LAPAROSCOPIC CHOLANGIOGRAPHY ODDI'S SPHINCTER TREATMENT OUTCOME