НАЗАД К УСЛУГАМSAFE LAPAROSCOPIC CHOLECYSTECTOMY

ХИРУРГИЯ ЖЕЛЧНОГО ПУЗЫРЯ

From symptomatic gallstones to acute inflammation, with systematic anatomical identification and safety strategies.

Автор медицинского материала: Efstratios K. KouroumpasСтраница обновлена: 30 августа 2026 г.

CRITICAL VIEW OF SAFETYICG / NIRBAIL-OUT STRATEGY

Примечание: навигация по странице доступна на русском языке. Подробный медицинский текст этой специализированной страницы пока отображается на английском.

ELIXIS · ADVANCED CARE

The goal is not simply removal — it is safe identification

Biliary anatomy is confirmed before division. When inflammation obscures planes, the strategy changes early.

СИМПТОМЫ

Symptoms that merit assessment

Many gallstones cause no symptoms. Temporary blockage of bile flow may cause biliary colic, while prolonged obstruction can lead to inflammation or other complications.

RIGHT UPPER PAIN

Pain in the right upper or central abdomen.

AFTER MEALS

Pain often follows a meal and may last from minutes to several hours.

TO BACK OR SHOULDER

Discomfort may travel to the back or right shoulder.

NAUSEA OR VOMITING

A pain episode may be accompanied by nausea or vomiting.

FEVER OR CHILLS

Fever or chills may indicate that inflammation has developed.

JAUNDICE

Yellow skin or eyes, dark urine and pale stools may indicate bile-duct obstruction.

Indigestion or bloating alone do not prove gallstone disease. Assessment combines history, examination, blood tests and usually ultrasound.

ОПЕРАЦИИ

Procedures and safety techniques

These are different clinical scenarios; not every option is used in every patient.

01GALLSTONES

SYMPTOMATIC GALLSTONE DISEASE

Before surgery is recommended, the symptoms are assessed to confirm that gallstones are the likely cause.

КОГДА РАССМАТРИВАЕТСЯ: Biliary colic, gallstone complications or another established indication.
ЧТО ВКЛЮЧАЕТ: Ultrasound, blood tests and common-duct assessment guide the appropriate plan.

02LAP CHOLE

LAPAROSCOPIC CHOLECYSTECTOMY

Removal of the gallbladder through small incisions for symptomatic stones.

КОГДА РАССМАТРИВАЕТСЯ: Symptomatic gallstones or a prior complication with a clear surgical indication.
ЧТО ВКЛЮЧАЕТ: Safe dissection, control of the cystic duct and artery, and protected specimen extraction.

03CVS

CRITICAL VIEW OF SAFETY

Three defined anatomical criteria before dividing the cystic duct and artery.

КОГДА РАССМАТРИВАЕТСЯ: A core safety goal in standard laparoscopic cholecystectomy.
ЧТО ВКЛЮЧАЕТ: All three criteria are required: the hepatocystic triangle is cleared of fat and fibrous tissue, the lower one third of the gallbladder is separated from the liver to expose the cystic plate, and two —and only two— structures are seen entering the gallbladder.

04ICG · NIR

ICG FLUORESCENCE CHOLANGIOGRAPHY

Intravenous ICG displays biliary anatomy with near-infrared imaging and no ionising radiation.

КОГДА РАССМАТРИВАЕТСЯ: Adjunctive mapping in selected laparoscopic procedures.
ЧТО ВКЛЮЧАЕТ: The fluorescence view is alternated with white light; it supports but does not replace safe dissection and surgical judgement.

05ACUTE

ACUTE CHOLECYSTITIS SURGERY

Early laparoscopic treatment of an inflamed gallbladder when clinically appropriate.

КОГДА РАССМАТРИВАЕТСЯ: Acute inflammation confirmed by clinical, laboratory and imaging findings.
ЧТО ВКЛЮЧАЕТ: Decompression when needed, careful dissection and early use of a safer bail-out strategy or conventional cholangiography when indicated.

06BAIL-OUT

SUBTOTAL CHOLECYSTECTOMY

A bail-out strategy when safe anatomical identification is not possible.

КОГДА РАССМАТРИВАЕТСЯ: Severe inflammation, fibrosis or hazardous anatomy in the hepatocystic triangle.
ЧТО ВКЛЮЧАЕТ: The safely accessible gallbladder and reachable stones are removed; the remnant and cystic duct are managed according to the anatomy. Bile leak and retained-stone risks remain.

Оригинальная реалистичная анатомическая иллюстрация для обучения — не фотография пациента.

ПЛАНИРОВАНИЕ И БЕЗОПАСНОСТЬ

Anatomy is confirmed before division

ICG and conventional cholangiography are distinct adjuncts. ICG uses no X-rays and does not reliably exclude common-duct stones; neither tool replaces the Critical View of Safety or surgical judgement.

TIME-OUT

A pause before division to confirm anatomy.

TWO STRUCTURES

Clear identification of cystic duct and artery.

IMAGING

ICG for adjunct anatomical mapping; conventional cholangiography when common-bile-duct imaging is needed.

BAIL-OUT

Early change of plan in hazardous anatomy.

ВОПРОСЫ

ЧАСТЫЕ ВОПРОСЫ

Краткие ответы перед индивидуальной консультацией хирурга.

01Is a minimally invasive approach always possible?

No. It is chosen when safe and meaningfully beneficial. Anatomy, previous surgery and complexity may require another approach or conversion.

02How long does recovery take?

Recovery varies with the procedure, disease severity and general health. The individual plan covers mobilisation, diet, work and exercise.

03Is ICG fluoroscopy?

No. It uses near-infrared fluorescence rather than ionising radiation. Contraindications and the possibility of a rare reaction must still be checked.

КЛИНИЧЕСКИЕ ДАННЫЕ

Окончательный выбор зависит от клинической картины, анатомии и актуальных рекомендаций.

01SAGES · Safe Cholecystectomy GuidelineCritical View of Safety and injury-prevention strategiesОФИЦИАЛЬНЫЙ ИСТОЧНИК 02SAGES · Fluorescence-Guided SurgeryClinical guidance for ICG fluorescenceОФИЦИАЛЬНЫЙ ИСТОЧНИК 03SAGES · Intraoperative CBD ImagingICG fluorescence and conventional X-ray cholangiographyОФИЦИАЛЬНЫЙ ИСТОЧНИК 04NIDDK · GallstonesSymptoms of gallstones and complicationsОФИЦИАЛЬНЫЙ ИСТОЧНИК

Информация носит образовательный характер и не заменяет осмотр врача. Риски и альтернативы обсуждаются индивидуально.

ИНДИВИДУАЛЬНАЯ ХИРУРГИЧЕСКАЯ ОЦЕНКА

Правильная операция начинается с правильных показаний.

На консультации оцениваются симптомы, исследования и альтернативы.

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