2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis.
2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis.
复制标题
DOI：
10.1186/s13017-020-00336-x
复制
发表时间：
2020-11-05
期刊：
影响因子：
--
通讯作者：
Ansaloni L
中科院分区：
文献类型：
--
作者：
Pisano M;Allievi N;Gurusamy K;Borzellino G;Cimbanassi S;Boerna D;Coccolini F;Tufo A;Di Martino M;Leung J;Sartelli M;Ceresoli M;Maier RV;Poiasina E;De Angelis N;Magnone S;Fugazzola P;Paolillo C;Coimbra R;Di Saverio S;De Simone B;Weber DG;Sakakushev BE;Lucianetti A;Kirkpatrick AW;Fraga GP;Wani I;Biffl WL;Chiara O;Abu-Zidan F;Moore EE;Leppäniemi A;Kluger Y;Catena F;Ansaloni L
急性结石性胆囊炎（ACC）在普通人群中发病率很高。几个不确定领域的存在，以及新证据的可用性，促使2016年WSES（世界急诊外科学会）ACC指南进行了更新。WSES会长从WSES的专家会员中选出4名科学干事、4名组织委员、4名科学委员。构建了相关的关键问题，并根据PubMed和EMBASE Library的最佳科学证据制作了每个部分的草稿；提出建议是为了回答这些关键问题。证据的质量和建议的强度使用分级建议评估，发展和评价（GRADE）标准进行审查（见https://www.gradeworkinggroup.org/）。2019年5月在奈梅亨（NL）举行的第六届世界急诊外科学会世界大会的共识会议上，所有声明都被提交、讨论和投票。通过在线问卷对声明的修订版本进行投票，直至达成共识。手术的关键作用已得到证实，包括在高危患者中。与WSES 2016指南相比，尽管有相当大的技术改进，但胆囊引流的作用降低了。只要有可能，早期腹腔镜胆囊切除术（ELC）应该是标准的护理，即使是在被认为是脆弱的患者亚组中，如老年人；患有心脏病、肾病和肝硬化者；或者那些手术风险很高的人。胆囊次全切除术是安全的，在胆囊切除困难的情况下是一种有价值的选择。ELC在ACC患者的管理中起着核心作用。对高危患者进行手术治疗的价值应该区分高危患者和不适合手术的患者。需要进一步的证据来证明临床判断的作用，以及使用临床评分作为辅助工具来指导高危患者和不适合手术患者的治疗。建议制定安全的腹腔镜胆囊切除术的地方政策。
Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.
登录
查看更多内容
影响因子：
1.4
作者：
Carter, Shawn S.;Ehsan, Syed Ramisa;Halkar, Raghuveer K.
通讯作者：
Halkar, Raghuveer K.
DOI：
10.4103/sjg.sjg_506_17
发表时间：
2018-05
期刊：
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
影响因子：
--
作者：
Ahmed O;Ogura T;Eldahrouty A;Khalaf H;Mohammed E;Okasha H;Sameer A;Abdelaal U;Higuchi K
通讯作者：
Higuchi K
DOI：
10.1007/s00464-007-9291-z
发表时间：
2007-09-01
影响因子：
3.1
作者：
Boddy, A. P.;Bennett, J. M. H.;Rhodes, M.
通讯作者：
Rhodes, M.
影响因子：
9.6
作者：
Alvarez, F. A.;de Santibanes, M.;Pekolj, J.
通讯作者：
Pekolj, J.
影响因子：
18.4
作者：
Abe, T;Kearns, CF;Fukunaga, T
通讯作者：
Fukunaga, T