لاپاراسکوپي امن، به صرفه ترين و کم عارضه ترين درمان سنگ هاي کيسه صفرا است. دکتر شهرام نظري، متخصص جراحي عمومي و لاپاروسکوپی پیشرفته دستگاه گوارش در گفت وگو با ايسنا، با بيان اين که لاپاراسکوپي يک روش نوين در خارج کردن سنگ هاي صفراوي و کيسه صفرا است، اظهار داشت: در اين روش با ايجاد چند سوراخ در جدار شکم، سنگ ها از کيسه صفرا خارج مي شوند. وي در توضيح گفت: لاپاراسکوپي کم تهاجمي ترين روش جراحي است که به عنوان يک ابزار تشخيصي و يک اقدام جراحي براي بررسي و معاينه اعضاي شکمي و لگني و يا قفسه سينه، سر و يا گردن انجام مي شود. عضو انجمن جراحان گوارش و لاپاراسکوپي آمريکا افزود: در لاپاراسکوپي با استفاده از سه سوراخ ۵ الي ۱۰ ميلي متري، جراحي انجام مي شود و جالب است بدانيد که تمام جراحي هاي زنان نظير برداشتن رحم، کيست تخمدان و بستن لوله از اين طريق قابل انجام است. وي در ادامه گفت: با در دسترس داشتن تجهيزات جديد اين امکان بوجود آمده که مانند عمل جراحي باز در يک مرحله سنگ کيسه صفرا و سنگ مجاري صفراوي را به طريقه لاپاراسکوپي همزمان از بدن خارج کنيم.در اینصورت نیاز به اقداماتی نظیر ERCP که علاوه بر مخارج مالی بیشتر، خطرات خاص خود را دارد، کمتر خواهد شد. اين فلوشيپ جراحي هاي لاپاراسکوپي پيشرفته اظهار داشت: انجام دادن اين عمل هم از نظر امنيت و هم از نظر اقتصادي براي بيمار به صرفه تر است و البته عوارض کمتري را براي بيمار به همراه دارد.
مقاله و سخنرانی شده در:
[toggle title=”Concomitant LCBDE improves the outcomes of Laparoscopic
.cholecystectomy”]
S.Nazari, MD1, 2, 3; S.M.Khosroushahi, MD8; S.H. Saba, MD7 ; A.Amini, MD4,5;S.Agah, MD6; H.R.Sarie, MD6
(۱)Department of Surgery, Erfan Hospital, Tehran, Iran
(۲)Department of Surgery, Milad Hospital, Tehran, Iran
(۳)Department of Surgery, Madaen Hospital, Tehran, Iran
(۴)Department of Emergency medicine, Imam Hosain Hospital, Tehran, Iran
(۵)Department of Emergency medicine, Erfan Hospital, Tehran, Iran
(۶)Department of Gastroenterology, Erfan Hospital, Tehran, Iran
(۷)Department of Internal Medicine, Erfan Hospital, Tehran, Iran
(۸) Department of Gynecology, Erfan Hospital, Tehran, Iran
CBD stones are found in approximately 16% of LC. In the beginning of laparoscopic era, because of an obvious lack of expertise in laparoscopic surgery, if the diagnosis of choledocholithiasis was established during IOC, the surgeons preferred postoperative ERCP instead of conversion to open surgery. With increasing experience of laparoscopic surgeons, it seemed logical to develop a mini-invasive one-stage laparoscopic approach. METHODS: This study evaluates our results of LCBDE in a series of 803 patients treated over 68 months and we evaluate the feasibility and safety LCBDE during LCs. RESULTS: CBD stones were demonstrated in 98 patients by routine IOC. For 7 patients, ERCP/ES was performed, with successful stone clearance after completion of LC. LCBDE was done in 91; all LCBDEs were completed laparoscopic. In 21 patients, CBD closed on a C-Tube and in 14 completed with T-tube insertion. In 31 cases no CBD drainage was performed. In 84 cases flexible choledochoscopy was done. Choledochoduodenostomy and choledochojejunostomy was done in 24 and 1 cases respectively. The mean operative time was 90-130 minutes (mean 95), which is significantly greater than conventional LC (range 20-40 minutes, mean 30). LCBDE was performed without immediate or late complications. CONCLUSION: There are no debates in the detection and the management of CBD stones in the era of LC. LCBDE is a cost-effective, efficient, and minimally invasive. RECOMMENDATION: We believe that for surgeons familiar with open common bile duct exploration and laparoscopic cholecystectomy, the next logical step is laparoscopic exploration of the common bile duct at the time of cholecystectomy, which is safe and readily mastered. It is hoped that LCBDE will be adopted so that patients can undergo a single procedure to remove their gallstones and common bile duct stones in one approach. LCBDE may decrease the rate of normal preoperative and complications of ERCP and second procedure postoperatively to clear retained CBD stones.
Keywords: Laparoscopic Cholecystectomy, Choledocholithiasis, common bile duct, stone, exploration.
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