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1. Verfasser:	Javier Ernesto Barreras González
Format:	Artículo científico
Sprache:	es
Veröffentlicht:	Universidad de Ciencias Médicas de La Habana 2010
Schlagworte:	Medicina Tratamiento Colelitiasis Coledocolitiasis Cirugía Laparoscópica Esfinterotomía endoscópica
Online-Zugang:	https://www.redalyc.org/articulo.oa?id=180418873012
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Coledocolitiasis. Opciones actuales de tratamiento laparoscópico y endoscópico Javier Ernesto Barreras González Julián Ruiz Torres Rafael Torres Peña Miguel Angel Martínez Alfonso Bárbara C Faife Faife José Manuel Hernández Gutiérrez Raúl Brizuela Quintanilla Medicina Tratamiento Colelitiasis Coledocolitiasis Cirugía Laparoscópica Esfinterotomía endoscópica Con el advenimiento de la colecistectomía laparoscópica en los años 80, la colangiografía retrógrada endoscópica con esfinterotomía endoscópica y la exploración laparoscópica de la vía biliar principal se ha cambiado el protocolo clásico de tratamiento de la coledocolitiasis. En la actualidad, existen diferentes estrategias terapéuticas para abordar la coledocolitiasis, en un intento de que los pacientes con esta afección se beneficien también de un abordaje mínimo invasivo. Sin embargo, no existe consenso respecto a cuál es el algoritmo de diagnóstico y tratamiento de la coledocolitiasis que pueda considerarse el patrón oro o gold standard, y el manejo de esta enfermedad depende hoy de la experiencia y las posibilidades de disponibilidad tecnológica de cada grupo de trabajo. El objetivo de este artículo es revisar las diferentes opciones técnicas de las que se dispone en la actualidad para el tratamiento de la coledocolitiasis, y describir sus resultados, ventajas y desventajas. 2010 artículo científico 1729-519X https://www.redalyc.org/articulo.oa?id=180418873012 es http://www.redalyc.org/revista.oa?id=1804 Revista Habanera de Ciencias Médicas application/pdf Universidad de Ciencias Médicas de La Habana Revista Habanera de Ciencias Médicas (Cuba) Num.3 Vol.9

if (filemtime($filename) + $maxlifetime < time()) { unlink($filename); $count++; } } return $count; } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ protected function saveSession($sessId, $data): bool { $sessFile = $this->path . '/sess_' . $sessId; if ($handle = fopen($sessFile, 'w')) { $return = false; // Lock the file for exclusive access to avoid issues with multiple // processes writing session simultaneously: if (flock($handle, LOCK_EX)) { $return = fwrite($handle, $data); // Make sure that there's no trailing data by truncating the file to // the correct length: ftruncate($handle, strlen($data)); fflush($handle); flock($handle, LOCK_UN); } fclose($handle); if ($return !== false) { return true; } } // If we got this far, something went wrong with the file output... // It is tempting to throw an exception here, but this code is called // outside of the context of exception handling, so all we can do is // echo a message.

// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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