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2016, vol. 55, br. 1, str. 5-13
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Savremeni prinicipi lečenja holecistita laparoskopskom tehnikom
Contemporary principles for cholecystitis treatment with laparoscopic technique
aHirurška klinika, Kliničko-bolnički centar Priština, Gračanica + Univerzitet u Prištini sa privremenim sedištem u Kosovskoj Mitrovici, Medicinski fakultet bKlinički centar Niš, Klinika za opštu hirurgiju + Univerzitet u Nišu, Medicinski fakultet cKlinički centar Niš, Klinika za opštu hirurgiju
e-adresa: slobodan.arandjelovic@med.pr.ac.rs
Sažetak
Prva laparoskopska holecistektomije (LH) izvedena je 1987. god. od strane francuskih hirurga (P. Mouret), od kada rapidno postaje prihvaćena do kraja devedestih godina u Evropi i Americi, te postaje "zlatni standard" u lečenju benignih bolesti žučne kese. "Malo je primera u istoriji hirurgije, gde se prednost jedne hirurške tehnike tako brzo nametnula, kao u slučaju laparoskopske holecistektomije"(Cusshieri). Podrazumevajući hiruršku veštinu i iskustvo, uigranost tima i specifičnu tehničku opremu, osnovne prednosti ove hirurške metode su manja operativna trauma i postoperativni bolovi, brži oporavak i kraće trajanje hospitalizacije. Procenat konverzija, odnosno prevođenja laparoskopske u klasičnu, otvorenu holecistektomiju je 2% do 20% i uslovljen je određenim uslovima, kao što su starije životno doba, patološka gojaznost, kao i izražena inflamcija žučne kese i anatomske anomalije bilijarnog stabla. Muški pol, prethodne operacije u trbuhu i tehnički problemi, su ređi uzroci konverzije. Nepoštovanje i neprepoznavanje ovih faktora rizika, može dovesti do komplikacija, od kojih je najznačajnija povreda glavnog žučnog voda. Na Hirurškoj klinici u Nišu, u periodu od 3 godine (januar 2010. do novembar 2013. god.) operisano je 1389 pacijenta zbog holecistitisa, od čega je 626 (45.1%) urađeno laparoskopskom tehnikom. U 60,10% radilo se o pacijentima ženskog, 39,90% muškog pola. Hronični kalkulozni holecistitis je bio indikacija u 86,20%, akutni u 8,50%, polip žučne kese u 5,30%. Konverzija je iznuđena kod 28 pacijenta (4,47%). Smrtni slučajevi u posmatranom periodu nisu zabeleženi, intraoperativnih lezija biliovaskularnih struktura nije bilo, ukupan specifični postoperativni morbiditet je iznosio 2.07%. Tehnički aspekt je i dalje dominantan kod LH. Izvanredni rezultati na našoj klinici kao i svetu, nameću potrebu daljeg razvoja ove metode, osavremenjavnja i edukacije hiruga i osoblja, sa ciljem smanjenja procenta kontraindikacija i tehničkih prepreka na minimum.
Abstract
The first laparoscopic cholecystectomy (LC) was performed in France in 1987 by a French surgeon (P. Mouret), and it rapidly became accepted until the end of the nineties in Europe and America as a 'gold standard' in the treatment of the gallbladder. 'There are just a few examples in the history of surgery, where the advantage of some surgical techniques is so quickly imposed, as it is in the case of laparoscopic cholecystectomy' (Cusshieri). Assuming the present of a surgical skill and experience, welltrained team and the specific technical equipment, the main advantages of this surgical method are less operative trauma and postoperative pain, faster recovery and a shorter hospital stay. The percentage of conversion to open cholecystectomy is 2%-20% and it is caused by certain conditions, such as older age, morbid obesity, and expressed inflammation of gallbladder and biliary anatomical anomalies. Male gender, anatomical variations, previous abdominal operations and technical problems, were rarer causes of conversion. Non-compliance and non-recognition of these risk factors can lead to complications, most notably the common bile duct injuries. At the Surgical Clinic in Nis, in the period of 3 years (January 2010 to November 2013) 1.389 patients with symptomatic cholelithiasis underwent surgery, 626 (45,1%) using standard techniques of laparoscopic method. Most patients, 60,10%, were female and 39,90% were male. Chronic calculous cholecystitis was an indication of the 86,20%, 8,50% in the acute, gallbladder polyp 5,30%. Conversion was forced out in 28 patients (4.47%). There have been no lethal operative outcomes in observed period, intraoperative lesions of vascular structures were not notified, total specific morbidity was about 2,07%. The technical aspect is still dominant at laparoscopic cholecystectomy (LC). Outstanding results at our clinic and in the world, impose the need for further development of this method, education of surgeons and staff, with the aim of reducing the percentage of contraindications and technical barriers to a minimum.
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Reference
|
|
1   
|
Angrisani, L., Lorenzo, M., De, P.G., Sivero, L., Catanzano, C., Tesauro, B., Persico, G. (1995) Laparoscopic cholecystectomy in obese patients compared with nonobese patients. Surgical laparoscopy & endoscopy, 5(3): 197-201
|
|
|
Archer, S.B., Brown, D.W., Smith, C. D., Branum, G.D., Hunter, J.G. (2001) Bile Duct Injury During Laparoscopic Cholecystectomy. Annals of Surgery, 234(4): 549-559
|
|
|
Arregui, M.E., Fitzgibbons, R.J.J., Katkhouda, N., Mckernan, J.B., Reich, H., editors (1995) Principles of laparoscopic Surgery. Basic and advanced techniques. Berlin: Springer-Verlag
|
|
|
Arulampalam, T., Paterson-Brown, S., Morris, A., Parker, M. (2009) Natural Orifice Transluminal Endoscopic Surgery. Annals of The Royal College of Surgeons of England, 91(6): 456-459
|
|
|
Beltramo, M., Henussi, G., Cazzaniga, M., Fraquelli, M. (1995) Cholecystectomy with laparoscopy and laparotomy. Analysis of the complications. Minerva-Chir, 50(7-8); 627-31
|
|
|
Bohacek, L., Pace, D.E. (2009) Advanced laparoscopic training and outcomes in laparoscopic cholecystectomy. Canadian journal of surgery. Journal canadien de chirurgie, 52(4): 291-294
|
|
|
Breitenstein, S., Nocito, A., Puhan, M., Held, U., Weber, M., Clavien, P. (2008) Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study. Annals of surgery, 247(6): 987-93
|
|
|
Brown, T.H., Irving, M.H., editors (1995) Introduction to Minimal Access Surgery. London: BMJ Publishing Group
|
|
|
Carey, L.C. (1992) Cholecystectomy--a new standard. Annals of surgery, 216(6): 617
|
|
1
|
Collet, D., Edye, M., Magne, E. (1992) Laparoscopic cholecystectomy in the obese patient. Surg Endosc, 6(4): 186-8
|
|
1
|
Constant, E., Janssen, P., Nys, J.M., Fouly, el P.E., Lemmens, F., Hachez, L., Hauters, P. (1995) Prospective analysis of 192 consecutive cholecystectomies: a comparative study between laparoscopy and laparotomy. Acta Chir Belg, 95(6); 254-60
|
|
|
Cuschieri, A., Buess, G., Perissat, J. (1994) Operative manual of Endoscopic surgery. Berlin: Springer-Verlag, 2nd ed
|
|
1  
|
Čolović, R. (2010) Forensic aspects of operative bile ducts injuries. Vojnosanitetski pregled, vol. 67, br. 2, str. 176-178
|
|
|
Čolović, R.B. (1999) Hirurgija bilijarnog trakta - Operacije na bilijarnom traktu. Beograd: Zavod za udžbenike i nastavna sredstva
|
|
1
|
Deziel, D.J., Millikan, K.W., Economou, S.G., Doolas, A., Ko, S.T., Airan, M.C. (1993) Complications of laparoscopic cholecystectomy: A national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg, 165(1): 9-14
|
|
1
|
Frazee, R.C., Roberts, J.W., Symmonds, R., Snyder, S.K., Hendricks, J., Smith, R., Custer, M.D. (1992) What are the contraindications for laparoscopic cholecystectomy?. American journal of surgery, 164(5): 491-4; discussion 494-5
|
|
2
|
Horwood, J., Akbar, F., Davis, K., Morgan, R. (2010) Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones. Annals of The Royal College of Surgeons of England, 92(3): 206-210
|
|
|
Hussain, A. (2011) Difficult laparoscopic cholecystectomy: current evidence and strategies of management. Surg Laparo Endo Per, 21(4); 211-7
|
|
|
Jaffary, S.A., Shamim, M.S., Razza, S.J., Dastagir, A. (2007) Instrument failure: A Preventable cause of conver sion in laparoscopic cholecystectomy. Pak J Surg, 23: 92-5
|
|
1
|
Jeremić, M. (2001) Hirurgija žučnih puteva. u: Jeremić M. [ur.] Specijalna hirurgija 1 - dijagnostika i terapija, Niš: Univerzitet u Nišu, Medicinski fakultet, p. 14/1-14/5
|
|
3
|
Liu, C.L., Fan, S.T., Lai, E.C., Lo, C.M., Chu, K.M. (1996) Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg, 131(1): 98-101
|
|
|
Loder, W.A., Minnich, M., Brotman, S. (1994) Hemodynamic effects of laparoscopic cholecystectomy. Am Surg, 60(5): 322-5
|
|
|
Markar, S.R., Karthikesalingam, A., Thrumurthy, S., Muirhead, L., Kinross, J., Paraskeva, P. (2012) Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surgical endoscopy, 26(5): 1205-13
|
|
|
Nagy, A.G., Poulin, E.C., Girotti, M.J., Litwin, D.E., Mamazza, J. (1992) History of laparoscopic surgery. Canadian journal of surgery. Journal canadien de chirurgie, 35(3): 271-4
|
|
|
Navarra, G., Pozza, E., Occhionorelli, S., Carcoforo, P., Donini, I. (1997) One-wound laparoscopic cholecystectomy. British journal of surgery, 84(5): 695
|
|
|
Podolsky, E.R., Rottman, S.J., Curcillo, P.G. (2009) Single Port Access (SPA) Cholecystectomy: Two Year Follow-up. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 13(4): 528-535
|
|
|
Singh, S., Khichy, S., Agrawal, N. (2015) Preoperative prediction of difficult laparoscopic cholecystectomy: A scoring method. Nigerian Journal of Surgery, 21(2): 130
|
|
|
Spaner, S.J., Warnock, G.L. (1997) A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J Laparoendosc Adv S, 7(6); 369-73
|
|
1
|
Tang, B., Cuschieri, A. (2006) Conversions During Laparoscopic Cholecystectomy: Risk Factors and Effects on Patient Outcome. Journal of Gastrointestinal Surgery, 10(7): 1081-1091
|
|
1
|
Tucker, J.J., Yanagawa, F., Grim, R., Bell, T., Ahuja, V. (2011) Laparoscopic cholecystectomy is safe but underused in the elderly. American surgeon, 77(8): 1014-20
|
|
|
Uragami, A., Matsumoto, H., Yamashita, K., Hirai, T., Tsunoda, T. (2005) Results of questionnaire surveys at several affiliated institutions regarding intraoperative biliary tract injuries. Tando J Jpn Biliary Assoc, 19: 299
|
|
|
van der Putten, E. P. W.-, Goossens, R. H. M., Jakimowicz, J. J., Dankelman, J. (2008) Haptics in minimally invasive surgery - a review. Minimally Invasive Therapy & Allied Technologies, 17(1): 3-16
|
|
|
Vecchio, R., MacFayden, B.V., Palazzo, F. (2000) History of laparoscopic surgery. Panminerva medica, 42(1): 87-90
|
|
|
Vivek, M.A.K.M., Augustine, A.J., Rao, R. (2014) A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. Journal of minimal access surgery, 10(2): 62-7
|
|
|
|
|