Запобігання ушкодженням жовчних проток при лапароскопічних холецистектоміях в умовах гострого деструктивного холециститу

Abstract

Выполнение лапароскопической холецистэктомии в условиях деструктивного холецистита связано с повышенным риском травмирования печёночных протоков. Обобщён собственный опыт лапароскопических холецистэктомий при деструктивном холецистите у 357 пациентов в возрасте от 20 до 92 лет. Установлен факт соответствия принятой в клинике хирургической тактики международным и национальным рекомендациям экспертов в контексте безопасности выполнения операций. Предложенные мероприятия в виде «критического взгляда со стороны» и приёма «чулка» в дополнении к основным рекомендациям экспертов позволяют успешно выполнять 93,8% операций при остром деструктивном холецистите в видеолапароскопическом режиме; Backround. The obvious advantages of laparoscopic cholecystectomy over traditional operations led to its rapid spread, as a method of treatment gallbladder diseases. The performance of a laparoscopic cholecystectomy in terms of destructive cholecystitis associated with an increased risk of injury to the hepatic ducts. Methods of research. Retrospective analysis of the statistical data of the informational-analytical Department admirer of them. M.V. Sklifosovsky, medical card patients with acute cholecystitis and histopathological studies macropreparation for 2005-2014, Summarized own experience of laparoscopic cholecystectomies in destructive cholecystitis in 357 patients at the age from 20 to 92 years old, among whom there were 109 men and 248 women. Results. Most patients (72.8%) in the preparation of the elements the Calot’s triangle was not difficult and laparoscopic cholecystectomy was performing in a classical way "from the cervix". Prior to the main real-time, more than half (58.8 %) patients needed pre-puncture of the gallbladder. When complex laparoscopic cholecystectomy preparation gall bladder performed from the bottom 19, a combined 34 and the receiving of the "stocking" in 21 cases. Special attention deserves organizational tactic "critical side view", which is introduced in our clinic and is in the presence of operating on the main stage competent in laparoscopic cholecystectomy surgeon, who is not a member of the core operating team. Established that compliance with clinic surgical tactics of international and national experts recommendations in the context of security operations. Conclusions. The proposed activities in the form of "critical side view" and taking the "stocking" in addition to the basic recommendations of experts can successfully implement 93.8% of transactions in acute destructive cholecystitis in video-assisted laparoscopic mode.