{"id":4286,"date":"2016-01-21T19:49:32","date_gmt":"2016-01-21T19:49:32","guid":{"rendered":"https:\/\/jurmed.ro\/pacienti\/?p=4286"},"modified":"2016-01-21T19:52:05","modified_gmt":"2016-01-21T19:52:05","slug":"cand-este-indicat-sa-ma-operez-de-colecist","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/pacienti\/cand-este-indicat-sa-ma-operez-de-colecist\/","title":{"rendered":"C\u00e2nd este indicat s\u0103 m\u0103 operez de colecist?"},"content":{"rendered":"

Litiaza vezicular\u0103 (pietrele la colecist, denumit \u0219i vezicul\u0103 biliar\u0103 sau \u201efiere\u201d) este o afec\u021biune frecvent\u0103, \u00eent\u00e2lnit\u0103 la 10-20% dintre persoanele cu v\u00e2rste \u00eentre 20 \u0219i 40 de ani \u0219i la 20% dintre cei care au dep\u0103\u0219it 40 de ani. \u00cen ultimele dou\u0103 decenii s-au \u00eenregistrat progrese importante \u00een diagnosticul \u0219i tratamentul acestei afec\u021biuni, \u00een beneficiul pacien\u021bilor.<\/p>\n

Care sunt marile nout\u0103<\/strong>\u021b<\/strong>i?<\/strong><\/span>
\n<\/strong><\/p>\n

\u00cen primul r\u00e2nd, mijloacele de diagnostic<\/strong> \u2013 \u00een special ecografia. Ecografia abdominal\u0103 este o metod\u0103 de diagnostic neinvaziv\u0103, care nu cauzeaz\u0103 nici un r\u0103u pacientului (f\u0103r\u0103 radia\u021bii, posibil de efectuat \u0219i la gravide), este rapid\u0103 \u0219i ieftin\u0103, fiind metoda de elec\u021bie \u00een stabilirea diagnosticului de litiaz\u0103 vezicular\u0103. Pietrele la colecist se v\u0103d de regul\u0103 foarte u\u0219or la ecografie. \u00cen concluzie, litiaza vezicular\u0103 este o afec\u021biune care se diagnosticheaz\u0103 u\u0219or.
\nA doua noutate este metoda de tratament chirurgical. Vorbim de laparoscopie<\/strong>, o interven\u021bie minim invaziv\u0103. Metoda clasic\u0103 presupune o incizie de 20-30-40 cm. subcostal drept sau pe linia median\u0103 supraombilical. Metoda laparoscopic\u0103 presupune patru mici incizii de 5 \u0219i de 10 mm. (fig.1), sau chiar o singur\u0103 incizie ombilical\u0103 de 3-4 cm., dac\u0103 este disponibil instrumentar de minilaparoscopie, av\u00e2nd un efect at\u00e2t func\u021bional c\u00e2t \u0219i estetic foarte important pentru pacient. Meritul abordului laparoscopic este c\u0103 a \u00eendep\u0103rtat multe dintre suferin\u021bele celor opera\u021bi. Datorit\u0103 noii metode chirurgicale, opera\u021bia este mai u\u0219or de suportat pentru pacient, cu o durat\u0103 de spitalizare scurt\u0103, \u00een medie de 1 sau 2 zile, cu cicatrici minuscule \u0219i f\u0103r\u0103 disconfort dureros dup\u0103 opera\u021bie.<\/p>\n

S\u0103 m\u0103 operez oare de colecist?<\/strong><\/span><\/p>\n

\u00cen fa\u021ba acestei \u00eentreb\u0103ri, pe care \u0219i-o pune orice pacient diagnosticat cu litiaz\u0103 vezicular\u0103, experien\u021ba m\u0103 determin\u0103 s\u0103 cred c\u0103 \u2013 pentru fiecare caz \u00een parte \u2013 trebuie s\u0103 se analizeze atent raportul risc-beneficiu, at\u00e2t pentru varianta de interven\u021bie chirurgical\u0103, c\u00e2t \u0219i pentru cea de absten\u021bie.<\/p>\n

Cel mai important beneficiu al interven\u021biei chirurgicale este evident: pacientul scap\u0103 de boala pe care o are. Organul bolnav este colecistul (vezicula biliar\u0103), el produce pietre (una sau mai multe, uneori sute de pietre, cu structur\u0103 diferit\u0103, de colesterol, calciu, pigmen\u021bi biliari sau mic\u0219ti) \u0219i el trebuie scos (nu doar pietrele). De altfel, opera\u021bia de eliminare doar a calculilor din colecist, denumit\u0103 colecistendez\u0103, nu se mai practic\u0103 de mai bine de 100 de ani.<\/p>\n

Cum se manifest\u0103 clinic litiaza vezicular\u0103?<\/strong><\/span><\/p>\n

Simptomele cele mai frecvente sunt durerile abdominale, sub form\u0103 de crize de intensitate diferit\u0103, declan\u0219ate de alimente cu con\u021binut mare de gr\u0103simi (toc\u0103tur\u0103, ou, carne gras\u0103, sm\u00e2nt\u00e2n\u0103, etc). Crizele se \u00eenso\u021besc \u0219i de alte semne (grea\u021b\u0103, v\u0103rs\u0103turi biliare), durata lor e de ordinul orelor \u0219i se lini\u0219tesc cu anumite medicamente; uneori pot s\u0103 treac\u0103 luni sau ani p\u00e2n\u0103 la urm\u0103toarea criz\u0103.<\/p>\n

\u00cen unele cazuri, litiaza vezicular\u0103 nu se manifest\u0103 \u00een nici un fel, nu sup\u0103r\u0103 deloc, este descoperit\u0103 \u00eent\u00e2mpl\u0103tor la ecografie. \u0218i atunci, de ce s\u0103 se opereze pacien\u021bii care nu au o simptomatologie dureroas\u0103? Pentru c\u0103 exist\u0103 complica\u021bii ale litiazei veziculare, frecvente \u0219i adeseori grave, care vor impune oricum efectuarea opera\u021biei, \u00eens\u0103 cu riscuri suplimentare pentru pacient.<\/p>\n

Voi enumera principalele complica\u021bii ale litiazei veziculare, care impun interven\u021bie chirurgical\u0103:<\/p>\n

    \n
  1. \u00a0Migrarea pietrelor din colecist<\/strong>. Ele pot migra p\u00e2n\u0103 la ie\u0219irea din colecist, \u00eempiedic\u00e2nd astfel complet func\u021bionarea lui, gener\u00e2nd ceea ce se cheam\u0103 hidrops vezicular. <\/em>Pietrele mai <\/em>pot migra \u00een canalul biliar principal (denumit \u0219i coledoc) \u0219i pot astfel determina icter mecanic <\/em>(\u00eeng\u0103lbenirea pielii prin v\u0103rsarea bilei \u00een s\u00e2nge), sau pot s\u0103 se impacteze la ie\u0219irea din canalul biliar principal, spre duoden (unde acesta se une\u0219te cu canalul pancreatic) \u0219i atunci se declan\u0219eaz\u0103 pancreatita de origine biliar\u0103<\/em>. \u00centr-un procent mai mic, pietrele pot s\u0103-\u0219i fac\u0103 drum din colecist spre alte organe din vecin\u0103tate (duoden sau colon transvers), produc\u00e2nd o fistul\u0103 bilo-digestiv\u0103,<\/em> adic\u0103 o comunicare anormal\u0103 \u00eentre dou\u0103 organe \u00eenvecinate.<\/li>\n
  2. Complica<\/strong>\u021b<\/strong>ii infec<\/strong>\u021b<\/strong>ioase<\/strong>, respectiv forme diverse de colecistite acute<\/em>, merg\u00e2nd p\u00e2n\u0103 la puroi \u00een colecist sau chiar constituirea de peritonite localizate <\/em>sau <\/em>generalizate<\/em>. Cauza acestora este perfora\u021bia colecistului \u0219i scurgerea con\u021binutului \u00een cavitatea peritoneal\u0103.<\/li>\n
  3. \u00a0Complica<\/strong>\u021b<\/strong>ii degenerative<\/strong>, respectiv cancerul de colecist<\/em>. Dovada c\u0103 prezen\u021ba pietrelor (timp de zeci de ani \u00eens\u0103) a generat cancerul veziculei biliare este dat\u0103 de faptul c\u0103 acest tip de cancer nu se \u00eent\u00e2lne\u0219te la pacien\u021bii f\u0103r\u0103 pietre la colecist.<\/li>\n<\/ol>\n

    Prin urmare, beneficiile interven\u021biei chirurgicale sunt chiar dispari\u021bia crizelor de durere abdominal\u0103 (\u00eempreun\u0103 cu toate celelalte simptome de boal\u0103) \u0219i evitarea apari\u021biei complica\u021biilor enumerate mai sus, care sunt frecvente \u0219i grave, uneori mortale.<\/p>\n

    Cum se face colecistectomia laparoscopic\u0103?\u00a0<\/strong><\/p>\n

    Colecistectomia laparoscopic\u0103 se practic\u0103 sub anestezie general\u0103. Pielea abdomenului\u00a0este aseptizat\u0103. Chirurgul face o mic\u0103 incizie\u00a0de 10-12 mm. aproape de ombilic. \u00cen cavitatea abdominal\u0103 este injectat dioxid de carbon (CO2<\/sub>), pentru a crea \u201ecamera de lucru\u201d. Acest fapt faciliteaz\u0103 observarea organelor interne cu laparoscopul, un sistem video introdus \u00een abdomen. Chirurgul\u00a0prive\u0219te imaginile pe un monitor conectat la laparoscop.
    \nSub control video se fac alte 3 incizii de dimensiuni mici, pentru a introduce trocare \u0219i instrumente de lucru \u00een cavitatea abdominal\u0103. Chirurgul vede \u0219i manevreaz\u0103 capetele acestor instrumente \u0219i efectueaz\u0103 astfel\u00a0procedurile propuse. La terminarea procedurii, CO2<\/sub> este exuflat, instrumentele sunt extrase, se cos inciziile cutanate \u0219i se lipesc pansamente.<\/p>\n

    Dup\u0103 colecistectomia laparoscopic\u0103 <\/strong>a\u0163i putea sim\u0163i o mic\u0103 durere \u00een jurul inciziilor. Este posibil s\u0103 ave\u0163i unele dureri la nivelul umerilor \u2013 acest lucru este cauzat de CO2<\/sub> care a fost insuflat \u00een interiorul abdomenului \u0219i care poate irita diafragmul, ce are aceea\u0219i surs\u0103 de inerva\u021bie ca \u0219i um\u0103rul. Aceast\u0103 durere trece repede. Durata de timp pentru recuperare \u0219i reintegrare social\u0103 este \u00een medie de 5-7 zile, cu indica\u021bia la externare de a respecta regim dietetic s\u0103rac \u00een gr\u0103simi.
    \nRezum\u00e2nd r\u0103spunsul la \u00eentrebarea din titlu, putem concluziona urm\u0103toarele:<\/p>\n

      \n
    • litiaza vezicular\u0103 se vindec\u0103 numai prin tratament chirurgical<\/em>, prin extirparea veziculei biliare;<\/li>\n
    • din moment ce tot se va ajunge la o opera<\/em>\u021b<\/em>ie, <\/em>este mult mai pu<\/em>\u021b<\/em>in riscant dac\u0103 interven<\/em>\u021b<\/em>ia chirurgical\u0103 se face \u00eentr-un stadiu \u00een care boala nu s-a complicat;<\/em><\/li>\n
    • chirurgia laparoscopic\u0103 este op<\/em>\u021b<\/em>iunea terapeutic\u0103 cea mai bun\u0103 la ora actual\u0103.<\/em><\/li>\n<\/ul>\n

      Autor: <\/strong>prof. Univ. dr. Viorel Scripcariu, medic primar chirurg, Coordonator Dpt. Specialit\u0103\u021bi Chirurgicale Arcadia Ia\u0219i<\/em><\/p>\n

      \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

      Litiaza vezicular\u0103 (pietrele la colecist, denumit \u0219i vezicul\u0103 biliar\u0103 sau \u201efiere\u201d) este o afec\u021biune frecvent\u0103, \u00eent\u00e2lnit\u0103 la 10-20% dintre persoanele cu v\u00e2rste \u00eentre 20 \u0219i 40 de ani \u0219i la […]<\/p>\n","protected":false},"author":4,"featured_media":4288,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[67,341],"tags":[],"class_list":["post-4286","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-chirurgie"],"yoast_head":"\nC\u00e2nd este indicat s\u0103 m\u0103 operez de colecist? - Jurmed - Pacienti<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/pacienti\/cand-este-indicat-sa-ma-operez-de-colecist\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"C\u00e2nd este indicat s\u0103 m\u0103 operez de colecist? 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