Журнал «Медицина неотложных состояний» Том 20, №5, 2024

Лапароскопічна холецистектомія пов’язана з вищою частотою ушкоджень жовчних шляхів і судин, ніж відкрита холецистектомія. Анатомічне неправильне сприйняття є найпоширенішим основним механізмом таких травм. Доведено, що критичний погляд на безпеку (CVS) є хорошим способом отримання надійної анатомічної ідентифікації. Його настійно пропонують різні рекомендації. Концептуально CVS — це метод ідентифікації мішеней, причому мішенями є дві міхурові структури. Це передбачає три основні кроки, а саме: 1) повне очищення печінково-міхурового трикутника від фіброзно-жирової тканини, 2) відокремлення нижньої частини жовчного міхура від міхурової пластинки так, що 3) видно дві і тільки дві структури, що входять у жовчний міхур. Іноді анатомічна ідентифікація неможлива, тому ризик ушкодження жовчних шляхів вважається занадто великим. Критичний погляд на безпеку може бути досягнутий у більшості випадків під час лапароскопічної холецистектомії. Однак його погане розуміння та низький рівень сприйняття серед практикуючих хірургів є глобальними проблемами. Підвищення обізнаності щодо критичного погляду на безпеку може збільшити його використання у рутинній хірургічній практиці.

Laparoscopic cholecystectomy is associated with a higher incidence of biliary/vasculary injuries than open cholecystectomy. Anatomical misperception is the most common underlying mechanism of such injuries. The critical view of safety (CVS) has been shown to be a good way of getting secure anatomical identification. It is highly recommended by various guidelines. Conceptually, CVS is a method of target identification, with the targets being the two cystic structures. It entails three basic steps as follows: 1) complete clearance of fibrous and fatty tissue from the hepatocystic triangle, 2) separation of the lower part of the gallbladder from the cystic plate, so that 3) two and only two structures are seen entering the gallbladder. Sometimes, anatomic identification is not possible because the risk of biliary injury is judged to be too great. The critical view of safety can be achieved in most cases during laparoscopic cholecystectomy. However, its poor understanding and low adoption rates among practicing surgeons have been global problems. Increasing awareness about the critical view of safety can increase its use in routine surgical practice.

лапароскопічна холецистектомія; печінково-міхуровий трикутник; міхурова протока; міхурова артерія; міхурова пластинка; критичний погляд на безпеку

laparoscopic cholecystectomy; hepatocystic triangle; cystic duct; cystic artery; cystic plate; critical view of safety

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