Аннотация

Цель
Оценить частоту и факторы ри ска возникновения торакальных грыж (ТГ) после ла пароскопической холецистэктомии (ЛХЭ)
Материал и методы
Проведено ретроспективное ис следование медицинских карт 400 пациентов, пере несших ЛХЭ по американской методике в 2017–2020 гг. Ультразвуко-вое исследование наряду с осмотром и пальпацией брюшной полости использовалось для уточнения диагноза ТГ. Минимальный период наблю дения — 5 лет.
Результаты
Средний возраст пациентов составил 51,9 ± 14,5 лет, соотношение женщин и мужчин — 2,2:1. Общая частота ТГ составила 21,7% (87/400), при этом большин-ство грыж развивалось в области пупка после использования троакаров диаметром более 10 мм. Установлено, что дополнительными фактора ми риска могут являться ожирение, необхо-димость расширения пупочного дефекта и наличие крупных желчных камней. Отсутствие или неадекватность фасциального закрытия также способствовали фор мированию ТГ.
Заключение
Частота развития ТГ после ЛХЭ может быть существенно выше обще-принятых оценок, осо бенно при длительном наблюдении. Введение круп ных троакаров в область пупка требует повышенного внимания, а профилактика ТГ должна включать ин ди-видуальную оценку анатомических особенностей брюшной стенки, тщательную технику фасциального закрытия и, при наличии сопутствующей грыжи, — проведение немедленной пластики.

Ключевые слова

торакальная грыжа лапароскопи ческая холецистэктомия.

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