Ятрогенные повреждения сосудисто-нервного пучка и лимфатических коллекторов бедренного треугольника при флебэктомии

Стремительное развитие инновационных медицинских технологий, расширение показаний к оперативному лечению, значительное увеличение числа выполняемых операций при варикозной болезни вен нижних конечностей, анализ литературы и данных крупных обсервационных исследований последних 20 лет позволяют констатировать неуклонный рост частоты ятрогенных повреждений сосудисто-нервного пучка и лимфатических коллекторов нижней конечности в хирургии варикозной болезни, что и явилось поводом для публикации данного обзора. Это может приводить к тяжелым осложнениям, требующим хирургического вмешательства, вызывает социальные и экономические последствия, связанные с необходимостью длительного амбулаторного и стационарного лечения, расходами на социальное обеспечение и выраженное снижение качества жизни. Сообщения о встречаемости данной патологии в медицинской литературе немногочисленны и, как правило, описывают исключительно редкие клинические случаи. Своевременная диагностика осложнений, тактика хирургического лечения пациентов с ятрогенными повреждениями при хирургическом лечении варикозной болезни и возможные варианты коррекции возникающих осложнений продолжают вызывать дискуссии и остаются одной из обсуждаемых проблем современной ангиохирургии. В статье проведен обзор литературы, посвященной анализу возможных причин ятрогении в хирургии варикозной болезни: повреждение сосудисто-нервного пучка и лимфатических сосудов бедренного треугольника, бедренной вены, большой подкожной вены, бедренной артерии, сочетанные повреждения артерии и вены, лимфатических узлов и коллекторов, подкожного нерва при флебэктомии. Рассмотрены вопросы диагностики и варианты коррекции возникших осложнений. Проблема ошибок и осложнений в хирургии вен должна решаться на основе комплексной подготовки хирургов-флебологов, включая обязательное обучение навыкам сосудистой хирургии, а также оснащения клиник специальным оборудованием и инструментарием. 

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