Patologia vesicular

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PATOLOGIA VESICULAR Dr. Roberto Avila Baylón R3CG Hospital General de León.

Transcript of Patologia vesicular

Page 1: Patologia vesicular

PATOLOGIA VESICULAR

Dr. Roberto Avila BaylónR3CG

Hospital General de León.

Page 2: Patologia vesicular

Vesícula Biliar

• Primera Qx. John Stougs Bobbs.• 15 julio colecistectomía. - 1882. Langenbuch.• Anthony Eden, complicacón, 1953.

Open Cholecystectomy. David McAneny, MD, FACS Section of Surgical Oncology And Endocrinology, Boston University School of Medicine. 2008.

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Vesicula Biliar

• 90% son laparoscopicas.• Riesgos para conversión :– Mayor de 60 años– Masculino.– Más de 65 kgs.

• Si no se opera en los primeros 2 o 3 días de iniciar el evento, mejor manejo medico por 6 semanas para resolver el cuadro.

Open Cholecystectomy. David McAneny, MD, FACS Section of Surgical Oncology And Endocrinology, Boston University School of Medicine. 2008.

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Vesicula Biliar

• Cerca del 1% de VB se observa un carcinoma.• En pacientes con cirrosis – Del 7% a 26% de mortalidad para colecistectomía.

• 1% de embarazos, desarrolla colelitiasis.• 10-20% de morbilidad• Pocentaje de conversión 1%.

Open Cholecystectomy. David McAneny, MD, FACS Section of Surgical Oncology And Endocrinology, Boston University School of Medicine. 2008.

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Vesicula Biliar

• Criterios para colecistitis :– Signos locales de inflamación, • Murphy, masa palpable, dolor y escalosfrios,

– Signos sistemicos de inflamación : fiebre, elevación de PCR de 3, leucocitosis mas de 18 mil.

– Imagen, 1 de A o B

J Hepatobiliary Pancreat Surg (2007) 14:78–82 Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. Masahiko Hirota

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COLECISTITIS

• Datos ulsanograficos :

– Murphy sonografico,

– Pared mayor de 4 mm.

– VB de 8 cms de long., más de 4.

– Sensibilidad del 97%, especificidad 76%.

J Hepatobiliary Pancreat Surg (2007) 14:78–82 Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. Masahiko Hirota

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COLECISTITIS

• Clasificacion :– LEVE, sin disfuncion organica y cambio inflamatorios en VB.– MODERADO, leucos de 18mil, masa palpable en CSD,

duracion de 72 hrs de inicio del cuadro, liquido perivesicular.

– SEVERO.• Cardiovascular, TA menor con aminas.• Neurologico, deterior sin perdida del estado de alerta, • Renal, oliguria o creatinina mayor de 2.0• Respiratoria con PaO2/FiO2 de menor de 300,• Hepatica, Tp-INR 1.5• Hematologica. Plaquetas menor de 100 mil.

J Hepatobiliary Pancreat Surg (2007) 14:78–82 Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. Masahiko Hirota

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COLECISTITIS

• I. colecistectomia laparoscopica.

• II. Datos de inflamacion local drenaje más

procedimiento quirurgico .

• III. Manejo urgente de la falla organica.

drenaje más colecistectomía abierta.

J Hepatobiliary Pancreat Surg (2007) 14:91–97. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines . Yuichi Yamashita

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COLECISTITIS

J Hepatobiliary Pancreat Surg (2007) 14:78–82 Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. Masahiko Hirota

Table 4. Incidence of acute cholecystitis after endoscopic treatment ofCholedocholithiasis Calculous gallbladder Acalculous gallbladder Average observation period (years)5.8% (11/190) — 6.828a7.6% (34/448) 1.2% (3/246) 7.52912% (2/17) 0% (0/15) 14.53022% (7/32) 1% (1/88) 10.231a Whether or not the whole population had calculous gallbladders is unknown

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COLECISTITIS

Table 1. Comparisons of early and delayed laparoscopic cholecystectomy for acute cholecystitis Length of Length of

Conversion Conversion Postoperative Postoperative hospital stay hospital stay Number rate of rate of complications complications (days) Early (days) DelayedAuthor of patients early LC delayed LC of early LC of delayed LC surgery surgeryLo et al.5 86 11% 23% 13% 29% 6 11Lai et al.6 91 21% 24% 9% 8% 7.6 11.6Chandler et al.7 43 24% 36% 4% 9% 5.4 7.1Johansson et al.15 143 31% 29% 18% 10% 5 8

LC, laparoscopic cholecystectomy; conversion rate, conversion rate to open surgery

J Hepatobiliary Pancreat Surg (2007) 14:91–97. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines . Yuichi Yamashita

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Vesicula Biliar

• Incision.• Aponeurosis,• Musculos• Vesicula,• Hepatocistico• Calot• Cierre por planos.

Open Cholecystectomy. David McAneny, MD, FACS Section of Surgical Oncology And Endocrinology, Boston University School of Medicine. 2008.

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COLECISTECTOMIA

• Gracias……