Tokin A N, Chistiakov A A, Mamalygina L A, Zheliabin D G, Osokin G Iu
Khirurgiia (Mosk). 2008(11):26-30.
Experience of diagnostics and treatment of 758 patients with acute cholecystitis was summarized. Authors attach the main importance to evaluation of ultrasound data and functional condition of respiratory and cardio-vascular sistem choosing the method of surgical treatment. Sparse use of laparoscopic cholecystectomy in treatment of acute cholecystitis compared with chronic may be explouned by presence of complications in patients which make problems in differentiation of tubular structures during the operation. Authors offered to use ultrasound dissection for clear identification of tubular structures and argon coagulation for hemostasis and safe mobilization of gall bladder. Stick to suggested tactics authors practically doubled the amount of performed laparoscopic cholecystectomies reducing at the same time the frequency of complications.
总结了758例急性胆囊炎患者的诊断和治疗经验。作者将主要重点放在评估超声数据以及呼吸和心血管系统的功能状况上,以此来选择手术治疗方法。与慢性胆囊炎相比,急性胆囊炎患者较少使用腹腔镜胆囊切除术,这可能是因为患者存在并发症,在手术过程中难以区分管状结构。作者建议使用超声解剖来清晰识别管状结构,并使用氩气凝固进行止血以及安全地游离胆囊。遵循建议的策略,作者实施的腹腔镜胆囊切除术数量几乎增加了一倍,同时并发症的发生率也有所降低。