IMPAIRMENT OF LAPAROSCOPIC CHOLECYSTECTOMY AND THEIR PROPHYLAXIS WAYS

S.I. HADIYEV, E.A. ABDINOV, K.H. SARIYEVA

Azerbaijan Medical University, Baku, AZERBAIJAN

He majority of the clinical practices show that, tough the operation of laparoscopic cholecystectomy (LCO) is little invasive, it can cause the heaviest, even the mortal impairments. Some works have been dedicated to the analysis of LCO impairments and the ways of their prophylaxis. 380 planned, 39 urgent LCO operations have been executed in 2008-2009 years clinically. The majority of the patients have been operated for gall-stone (355), and others for the polyp of the gall-bladder (25). The age of the patients changes between 16-82 ages. The interoperation impairment has been observed in 10 patients (2.3%) during the laparoscopic operations: the bleeding in the abdominal cavity in 6 patients (1.4%), the damage of small intestine in 1 patient (0.2%), hypodermic emphysema in 1 patient (0.2%), the damage of mesenterium in 1 patient (0.2%), the damage of the right liver artery in 1 patient (0.2%). The postoperating impairments in 24 (5.7% ) patients have been observed: the gall peritonitis for the weakness of the sack flow remainder - 2, postoperating pancreatitis – 1, the pneumonia in the lower parts of the lungs – 3, early intestine obstruction with joining origin – 1, infiltration and hematoma in the stomach wallin the place where the trocar passes – 7, suppuration of the wound around the omphalos – 4, thromboembolism of the lung artery – 1, sharp psychosis – 1. So, the number of LCO impairments is 8.1%. The laparotomy has been executed in 10 patients in order to remove the impairments, the laparoscopic intervention in 7 patients, hypogynous abscess paracentetic – drainage sanation in 2 patients have been executed. 1 patient died from the thromboembolism of the lung artery. During the laparoscopic intervention the intra-abdominal pressure wasn’t higher than 8 mm mercury column in the patients which the risk of formation of these impairments with the purpose of heart-vascular and lung impairments prophylaxis, the monitoring of the respiratory and homodynamic parameters have been carried out. At present the clexan and fraxyparin injections are applied connected with the risk degree on scheme with the purpose of the thromboembolism prophylaxis. Sack flow is cut after the determination of its exit place from the sack and after the specifying the place of the sack artery in the sack wall.

It is necessary to sew the aponeurosis defect in order to prevent the formation of the hole around the omphalos and in order to expand the wound after taking out of the gall-bladder in the patients who has fatness. It is advisable to finish the operation with the drainage of the hypogynous area in all patients. Even during the clinical procedure without the complication, it is necessary to carry out the ultrasound inspection of the hypogynous area during the period after the operation.

Date: 2014-12-28; view: 984