24 KB92 KB19 KB200520132005Požar-Lukanovič, NevaSojar, ValentinStanisavljević, Dragojeletnik:10številka:246 stranistr. 89-94ISSN:1318-8941COBISSID:20599769URN:URN:NBN:SI:doc-CVVMZTFUenSlovensko zdravniško društvoEndoskopska revijaCarbon MonoxideHemodinamikahemodinamski nadzorHemodynamicsHepatectomyHepatektomijajetrakirurško zdravljenjelaparoskopska kirurgijaOgljikov monoksidSurgery, LaparoscopicHaemodynamic monitoring during laparoscopic liver resection| Hemodinamski nadzor med laparoskopsko jetrno resekcijo|Introduction. Minimally invasive surgery has been gaining popularity because of its clear advantages over open surgery, which include: lesser surgical trauma, shorter hospital stay, better cosmetical effect and improved patient satisfaction. Greater experience gained in both laparoscopy and liver surgery has made laparoscopy a technically feasible and safe treatment option for someliver resections. Patients and Methods. Haemodynamic monitoring during minimally invasive surgery: the term "minimally invasive surgery" does not imply that this surgical technique carries less perioperative risk for the patient. Perioperative hazards of laparoscopic liver resection are mostly the same as in open liver surgery. These include: massive bleeding, haemodynamic instability due to compression of the inferior vena cava anaphylactic reactionin patients with echinococcus disease. In addition, there may be haemodynamic effects of pneumoperitoneum, such as decreased preload, increasedsystemic vascular resistance, decreased cardiac output, and increasedrisk for CO2 embolism. The greatest benefits offered by the minimallyinvasive approach are the patients comfort and safety. From the standpoint of the anaesthesiologist this goal is best met by perioperative monitoring, which allows for timely detection of potentially dangerous events and for appropriate action. Results. Since January 1997, 31 patients with liver disease have been treated laparoscopicaly in this institution. In three cases, occlusion of the hepatoduodenal ligament was used to control the bleeding. In one patient-the only one who needed blood transfusion-conversion to open surgery was required because of bleeding. (Abstract truncated at 2000 characters)Uvod. V zadnjih letih so minimalno invazivni postopki v kirurgiji vse bolj priljubljeni. V primerjavi s klasičnimi operacijami je kirurška poškodba manjša, bolniki ostanejo v bolnišnici manj časa, kozmetični videz je manj prizadet in bolniki so bolj zadovoljni. Zaradi novih znanj in izkušenj v jetrni kirurgiji in laparoskopskih tehnikah je nekatere jetrne resekcije možnovarno narediti na laparoskopski način. Bolniki in metode. Nadzor obtočil med minimalno invazivnimi operacijami: pojem minimalno invazivna kirurgija ne vključuje tudi minimalnega tveganja za bolnika med posegom. Tveganje med laparoskopsko jetrno resekcijo (LJR) je enako kot med klasičnim posegom: obsežna krvavitev, hemodinamska nestabilnost in anafilaktična reakcija pri bolnikih z ehinokoknimi spremembami v jetrih. Tem zapletom se pridružijo še hemodinamski učinki pnevmoperitoneja: zmanjšan pritok krvi v srce, povečan upor ožilja, zmanjšan minutni volumen srca (MV) in nevarnost embolije s CO2. Sstališča anesteziologa zagotovimo bolniku največjo varnost z nadzorom, ki omogoča hitro zaznavo in pravočasno ukrepanje ob zapletih. Rezultati. Od januarja 1997 smo laparoskopsko operirali 31 bolnikov z boleznijo jeter. Pri treh bolnikih smo zaradi kontrole hemostaze uporabili zaporo hepatoduodenalnega ligamenta. Pri enem bolniku - ta je bil edini, ki je potreboval transfuzijo krvi - smo morali preklopiti v odprt kirurški poseg. Zaključek. Glede na trenutne možnosti minimalno invazivni nadzor pri LJR ni priporočljiv. Hitre spremembe hemodinamike terjajo invazivno merjenje krvnega tlaka in i.v. port s širokim premerom za zdravljenje s tekočinami in transfuzijo krvnih pripravkov. (Izvleček skrajšan na 2000 znakov)TEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo, Združenje za endoskopsko kirurgijo