Magyar Sebészet
Volume/Issue:
Volume 73: Issue 2
Cholecystectomia során bekövetkező epeútsérülések ellátása
Authors:
Bánk Keczer Semmelweis Egyetem, Budapest

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Nándor Csuja Semmelweis Egyetem, Budapest

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András Fülöp Semmelweis Egyetem, Budapest

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Damján Pekli Semmelweis Egyetem, Budapest

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László Harsányi Semmelweis Egyetem, Budapest

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István Hritz Semmelweis Egyetem, Budapest

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Attila Szijártó Semmelweis Egyetem, Budapest

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Pages:
49–56
Online Publication Date:
Jun 2020
Publication Date:
01 Jun 2020
Article Category:
Research Article
DOI:
https://doi.org/10.1556/1046.73.2020.2.1
Keywords:
epeúti sérülés; laparoszkópos cholecystectomia; posztoperatív szövődmények; bile duct injury; laparoscopic cholecystectomy; postoperative complications
Open access

Absztrakt:

A laparoszkópos cholecystectomia (LC) a leggyakrabban végzett műtétek egyike. A beavatkozás ritka, ugyanakkor nagyon súlyos szövődménye az epeúti sérülés. Célunk az LC, valamint laparoszkópos kezdés után konvertált műtétek során bekövetkezett epeúti sérülések és szövődményeik, valamint ezek ellátásának vizsgálata volt.

Vizsgálatainkat a Semmelweis Egyetem I. sz. Sebészeti Klinikáján 2006–2016 között epehólyag-eltávolításra került betegek dokumentációjának retrospektív elemzésével végeztük.

Tizenegy év alatt 4 885 cholecystectomiát végeztünk. Ebből 4 558 (93,3%) laparoszkópos műtét, melyből 30 betegnél fordult elő valamilyen szövődmény, ami az összes LC 0,66%-a. A konvertált műtétek közül 7,95%-ban (26/327) lépett fel szövődmény. Más intézményből 22 szövődményes beteget utaltak Klinikánkra. Epeút-, illetve érsérülés 41 esetben fordult elő (61%, 41/78). Epeúti sérülés ellátása során 25 esetben került sor epeúti intervencióra (ERCP), 92%-os siker aránnyal. Reoperációra az epeúti sérült betegek 68%-nál volt szükség (28/41), melynek során a végleges epeúti rekonstrukció 82%-ban hepaticojejunostomia segítségével történt.

Következtetés: A laparoszkópos cholecystectomia a XXI. században is rutin beavatkozásának tekinthető, ugyanakkor a szövődmények terápiás megoldása továbbra is nehéz. A szövődményes esetek ellátása csak nagy gyakorlatú, multidiszciplináris háttérrel rendelkező intézményekben javasolt.

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Magyar Sebészet
Language Hungarian
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Foundation		 1947
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Founder Magyar Sebész Társaság -- Hungarian Surgical Society
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ISSN 0025-0295 (Print)
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