31 KB214 KB23 KB200520132005Grilc, AnaJanež, FrancMalavašič, RokMušič, MarkSkračić Smrekar, Koraljkaletnik:10številka:248 stranistr. 105-112ISSN:1318-8941COBISSID:20600281URN:URN:NBN:SI:doc-ZX3NQOP2slSlovensko zdravniško društvoEndoskopska revijaCholecystectomy, LaparoscopicHolecistoktemija laparoskopskakirurško zdravljenjelaparoskopska kirurgijapoškodbeTreatment OutcomezapletiZdravljenje, izidžolčnik12 let laparoskopskih holecistektomij in analiza zgodnjih zapletov| 12 years of laparascopic cholecystectomies and analysis of early complications|Background. From December 1992 to the end of 2004, 1979 laparoscopic cholecystectomies were done at the Surgical Department of the Novo mesto General Hospital. The proportion of laparoscopic cholecystectomies, which had been low until 1997, has increased over the past two years to reach 82 per cent of all biliary operations. In 2004, 5.4 per cent of conversions were recorded. The paper analyses early complications associated with laparoscopic cholecystectomies performed in this institution. In addition to statistical analysis and comparison of results, the paper investigates the causes and consequences of early complications, particularly of iatrogenic biliary injuries. Patients and methods. Seven early complications were documented during a period of 12 years. Two common bile duct injuries, categorized as type E1 according to the Strasberg classification, were identified intraoperatively and managed by accomplishing anastomosis of the common bile duct and by inserting a T-tube. Three patients developed bleeding and had to be reoperated on the same day. In two cases, the laparoscopic approach had to be converted to an open procedure to allow for blood clot removal. In one case, revision of a haemotoma in the postoperative wound was required after the insertion of a supraumbilical trocar. A conventional approach was used in two cases with improperly laced metal clamps. In one patient, the cystic duct clamp was found to be too short and had to be replaced by two larger ones. In another case, compression of the common bile duct by a clamp was suspected at ERCP; the clamp was removed and the cystic duct was ligated in the classical manner. (Abstract trunacted at 2000 characters)Izhodišča. Od decembra 1992 do konca leta 2004 smo na kirurškem oddelku splošne bolnišnice v Novem mestu opravili 1979 laparoskopskih holecistektomij.Do leta 1997 je bil delež laparoskopskih holecistektomij skromen, nato se je postopoma povečeval, v zadnjih dveh letih na prek 82% vsehoperacij žolčnika. Ob tem beležimo v letu 2004 5,4% preklopov. V našem prispevku analiziramo zgodnje zaplete laparoskopskih holecistektomij v naši bolnišnici. Poleg statistične analize in primerjave rezultatov, predvsem gledena poškodbe žolčevodov, smo obravnavali tudi vzroke in posledice, ki so vodili do posameznega zapleta. Bolniki in metode. V dvanajstletnem obdobju smozabeležili 7 zgodnjih zapletov. Obe poškodbi glavnega žolčevoda sta bili prepoznani med posegom. Poškodbi sta bili v obeh primerih tipa E1 po Strasbergovi klasifikaciji, rešili smo ju z anastomozo med koncema glavnega žolčevoda in vstavitvijo T-drena. Pri treh primerih krvavitve smo bolnika ponovno operirali še istega dne. V dveh primerih smo poizkusili z laparoskopskim pristopom, vendar smo morali obakrat opraviti preklop zaradi odstranitve koagulov. V tretjem primeru smo revidirali le hematom v pooperativni rani po vstavitvi troakarja nad popkom. V obeh primerih nepravilno postavljenih kovinskih sponk smo pristopili klasično. V prvem primeru smo prekratko sponko na cističnem vodu zamenjali z dvema večjima. V drugem primeru, ko je bil na ERCP postavljen sum, da sponka od strani pretiskaglavni žolčevod, smo jo odstranili ter cistični vod podvezali klasično. (Izvleček skrajšan na 2000 znakov)TEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo, Združenje za endoskopsko kirurgijo