grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-46252686-7370Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2024-183-4-70-76grekov-2429Research ArticleОБЗОРЫREVIEWSТравма желчных протоков при лапароскопической холецистэктомии: современное состояние проблемыBile ducts injury during laparoscopic cholecystectomy: current state of the problemhttps://orcid.org/0000-0002-8830-5073ВласовА. В.VlasovA. V.

Власов Александр Викторович, кандидат медицинских наук, доцент кафедры факультетской хирургии и трансплантологии

603005, г. Нижний Новгород, пл. Минина и Пожарского, д. 10/1

 

Vlasov Alexander V., Cand. of Sci. (Med.), Associate Professor of the Department of Faculty Surgery and Transplantology

10/1, Minina i Pozharskogo square, Nizhniy Novgorod, Russia, 603005

asovalexv@mail.ruhttps://orcid.org/0000-0002-7903-7206ПанюшкинА. В.PanyushkinA. V.

Панюшкин Алексей Вячеславович, зав. хирургическим отделением

603011, Россия, г. Нижний Новгород, ул. Октябрьской революции, д. 66а

Panyushkin Alexey V., Head of the Surgical Department, City Clinical Hospital № 7 of the Leninsky district of Nizhny Novgorod named after E. L. Berezov

66a Oktyabr`skoj revolyucii str., Nizhniy Novgorod,  603011

https://orcid.org/0009-0003-4904-0185ЖидковИ. М.ZhidkovI. M.

Жидков Илья Михайлович, студент 6 курса

603005, г. Нижний Новгород, пл. Минина и Пожарского, д. 10/1

Zhidkov Ilya M., 6th year Student

10/1, Minina i Pozharskogo square, Nizhniy Novgorod, Russia, 603005

https://orcid.org/0009-0007-3056-9301БарановаД. Г.BaranovaD. G.

Баранова Дарья Геннадьевна, студент 6 курса

603005, г. Нижний Новгород, пл. Минина и Пожарского, д. 10/1

 

Baranova Darya G., 6th year Student

10/1, Minina i Pozharskogo square, Nizhniy Novgorod, Russia, 603005

 

Приволжский исследовательский медицинский университетРоссияPrivolzhsky Research Medical UniversityRussian FederationГородская клиническая больница № 7 Ленинского района г. Нижнего Новгорода имени Е. Л. БерезоваРоссияE. L. Berezov City Clinical Hospital № 7 of the Leninsky district of Nizhny NovgorodRussian Federation20242706202418347076Copyright © Власов А.В., Панюшкин А.В., Жидков И.М., Баранова Д.Г., 20242024Власов А.В., Панюшкин А.В., Жидков И.М., Баранова Д.Г.Vlasov A.V., Panyushkin A.V., Zhidkov I.M., Baranova D.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/2429

Травмы желчных протоков возникают в 0,4 % плановых и в 0,8 % экстренных лапароскопических холецистэктомий. Изучены факторы риска повреждений желчных протоков и оптимальные сроки выполнения лапароскопической холецистэктомии. Акцент делается на теоретической и практической подготовке хирурга как главной составляющей профилактики травм желчных протоков. Описаны вариантная анатомия сосудов, желчевыводящих протоков и важные анатомические ориентиры при выполнении операции. Во время «сложной холецистэктомии» предлагаются «стратегии спасения», рассматриваются современные методы визуализации. Оценивается концепция безопасной холецистэктомии. Затронуты вопросы классификации повреждений. Анализ литературы показал, что в мировом хирургическом сообществе продолжаются дебаты о правильных тактиках ведения данных пациентов. Также существует проблема в оценке осложнений и отсутствует стандартизация исходов после лапароскопической холецистэктомии.

Bile duct injuries occur in 0.4 % of elective and 0.8 % of emergency laparoscopic cholecystectomies. The risk factors for bile duct damage and the optimal timing of laparoscopic cholecystectomy were studied. The emphasis is on theoretical and practical training of the surgeon as the main component of the prevention of bile duct injuries. The variant anatomy of vessels, bile ducts and important anatomical landmarks during the operation are described. During «complex cholecystectomy», «rescue strategies» are proposed and modern imaging techniques are reviewed. The concept of safe cholecystectomy is evaluated. The issues of damage classification are touched upon. Analysis of the literature showed that debate continues in the global surgical community about the correct tactics for managing these patients. There is also a problem in assessing complications and there is a lack of standardization of outcomes after laparoscopic cholecystectomy.

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The authors declare that there are no conflicts of interest present.