Журнал «Медицина неотложных состояний» Том 20, №7, 2024

Рівень ушкодження жовчних проток при лапароскопічній холецистектомії залишається вищим, ніж при відкритій холецистектомії. Інтраопераційні пошкодження здебільшого є результатом неправильної інтерпретації анатомічних структур через серйозне запалення або топографічні зміни. Стандартна лапароскопічна холецистектомія потребує правильної дисекції трикутника Calot для досягнення критичного погляду на безпеку (CVS — critical view of safety). CVS є кінцевим продуктом процесу дисекції, і пошкодження жовчних проток виникають до завершення цього процесу. CVS не завжди можна досягти у випадках тяжкого холециститу через технічні труднощі. Повна стратегія безпеки повинна включати раннє розпізнавання труднощів та ідентифікацію холецистектомій у випадках, коли неможливо досягти CVS, щоб використовувати нові інтраопераційні технології для уточнення анатомії. Фіксовані анатомічні орієнтири можуть допомогти в орієнтації для правильного визначення хірургічної анатомії під час операції. У цьому огляді міститься інформація про критичні орієнтири для оцінки розташування життєво важливих структур у скомпрометованих анатомічних умовах.

Bile duct injury rates in laparoscopic cholecystectomy remain higher than during open cholecystectomy. Intraoperative injuries are mostly the result of a misinterpretation of anatomical structures due to severe inflammation or topographical variations. Standard laparoscopic cholecystectomy requires proper dissection of Calot’s triangle to achieve the critical view of safety (CVS). The CVS is the end product of dissection, and bile duct injuries occur before the conclusion of that process. The CVS cannot always be achieved in cases of severe cholecystitis because of technical difficulties. A complete strategy of safety should therefore include early recognition of difficulties and identification of cholecystectomies, when the CVS cannot be achieved, in order to utilize new intraoperative technologies to clarify the anatomy. Fixed anatomical landmarks can help in proper orientation to ascertain the surgical anatomy correctly during surgery. Encompassed within the review are insights into identifying critical landmarks for assessing the positioning of vital structures in compromised anatomical conditions.

лапароскопічна холецистектомія; критичний погляд на безпеку; анатомічні орієнтири

laparoscopic cholecystectomy; critical view of safety; anatomical landmarks

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