Prednosti hitnih operacijskih zahvata kod akutne upale žučnjaka u usporedbi s odgođenim operativnim zahvatom

master's thesis

• Title (english): Benefits of early surgical procedure in acute cholecystitis in comparison to delayed surgical procedure
• Author: Tea Grgić
• Mentor: Žarko Rašić (mentor)
• Committee member: Dujo Kovačević (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Žarko Rašić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Akutni kolecistitis je akutna upala žučnoga mjehura i jedna od najčešćih komplikacija simptomatskih žučnih kamenaca. Čimbenici rizika za nastanak žučnih kamenaca su životna dob, spol, pretilost, te genetika. Akutna opstrukcija žučnoga mjehura kamencem dovodi do napadaja - stalne boli koja se javlja u epigastriju i gornjem desnom kvadrantu trbuha, može sijevati u leđa, interskapularnu regiju ili u desno rame. Postavljanje dijagnoze prvi je korak u obradi akutnog kolecistitisa, a specifični dijagnostički kriteriji potrebni su za što točnije postavljanje dijagnoze kako tipičnih, tako i atipičnih slučajeva. Znakovi koji potvrđuju dijagnozu akutnog kolecistitisa su ultrazvučni Murphyev znak, zadebljana stijenka žučnog mjehura te uvećani žučni mjehur.
U vrijeme otvorenih zahvata kolecistektomije davala se prednost ranoj kolecistektomiji pred kasnim elektivnim zahvatom. U novijim randomiziranim studijama dobivaju se slični rezultati za ranu laparoskopsku kolecistektomiju. Za rani laparoskopski zahvat u akutnim situacijama ključni su: operacija za manje od 72 sata nakon pojave akutnog napadaja, kirurg s iskustvom više od 200 kolecistektomija, te kvalificirano pomoćno osoblje i dobri instrumenti za napredni laparoskopski zahvat.
Studije ukazuju na siguran rani laparoskopski zahvat u liječenju akutnog kolecistitisa. Odgađanje zahvata do povlačenja simptoma tijekom iste hospitalizacije ne pokazuje prednost ni u trajanju zahvata, niti u učestalosti komplikacija. Rani zahvat ima manji gubitak krvi tijekom operacije, pokazuje sklonost manjoj potrebi za konverzijom u otvoreni zahvat, te značajno smanjuje ukupno trajanje liječenja i ukupne troškove liječenja. Rezultati potiču korištenje ranog zahvata tijekom prvog prijema bolesnika u bolnicu radi akutnog kolecistitisa. Unatoč nešto dužem postoperativnom boravku u bolnici, ukupan boravak i oporavak značajno su kraći. Rana laparoskopska kolecistektomija kombinira glavne značajke ranog zahvata i one minimalno invazivnog zahvata, te tako osigurava maksimalnu ekonomsku dobit.

Abstract (english)

Acute cholecystitis is an acute inflammation of the gallbladder and one of the most common complications of symptomatic gallstones. Risk factors for gallstones are age, gender, obesity, and genetics. Acute obstruction of the gallbladder with stones leads to seizures - constant pain that occurs in the epigastrium and right upper quadrant of the abdomen, can pierce to the back, to interscapular region or in the right shoulder. Diagnosis is the first step in the treatment of acute cholecystitis, and specific diagnostic criteria are needed for the precise diagnosis in typical, as in atypical cases. Signs that confirm a diagnosis of acute cholecystitis ultrasonic Murphy's sign, thickened gallbladder wall and an enlarged gallbladder.
In the time of open cholecystectomy, the advantage was given to the early cholecystectomy before late elective surgery. Recent randomized studies obtained similar results for early laparoscopic cholecystectomy. Essentials for performing a laparoscopic cholecystectomy for very acute situations are: to operate less than 72 hours from the onset of the acute attack, an experienced surgeon with more than 200 cholecystectomies, nurses well trained in advanced laparoscopic procedures, and good instrumentation.
.Studies indicate that early laparoscopic surgery in the treatment of acute cholecystitis is safe. Delay in operation until resolution of simptoms during the same hospitalization showed no adventage with regard to operative time or complication rate. Furthermore, early laparoscopic intervention significantly reduced operative blood loss, showed a trend toward reducing conversion rates, and significantly reduced total hospital days and total hospital charges. These findings support the use of early laparoscopic cholecystectomy during the first admission in the treatmant of acute cholecystitis.Despite a longer postoperative hospital stay, the total hospital stay and the recuperation period are significantly reduced. Early laparoscopic cholecystectomy combines the merits of early surgery with those of minimally invasive surgery and can provide maximal economic gain.

• Keywords: akutni kolecistitis; dijagnostički kriteriji; liječenje; kirurški zahvat; laparoskopija
• Keywords (english): acute cholecystitis; diagnostic criteria; treatment; surgical procedures; laparoscopy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:617539
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-11-19 09:22:53