Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
J Hepatobiliary Pancreat Sci. 2013 Jan;20(1):89-96. doi: 10.1007/s00534-012-0567-x.
Laparoscopic cholecystectomy is now accepted as a surgical procedure for acute cholecystitis when it is performed by an expert surgeon. There are several lines of strong evidence, such as randomized controlled trials (RCTs) and meta-analyses, supporting the introduction of laparoscopic cholecystectomy for patients with acute cholecystitis. The updated Tokyo Guidelines 2013 (TG13) describe the surgical treatment for acute cholecystitis according to the grade of severity, the timing, and the procedure used for cholecystitis in a question-and-answer format using the evidence concerning surgical management of acute cholecystitis.
Forty-eight publications were selected for a careful examination of their full texts, and the types of surgical management of acute cholecystitis were investigated using this evidence. The items concerning the surgical management of acute cholecystitis were the optimal surgical treatment for acute cholecystitis according to the grade of severity, optimal timing for the cholecystectomy, surgical procedure used for cholecystectomy, optimal timing of the conversion of cholecystectomy from laparoscopic to open surgery, and the complications of laparoscopic cholecystectomy.
There were eight RCTs and four meta-analyses concerning the optimal timing of the cholecystectomy. Consequently, it was found that cholecystectomy is preferable early after admission. There were three RCTs and two meta-analyses concerning the surgical procedure, which concluded that laparoscopic cholecystectomy is preferable to open procedures. Literature concerning the surgical treatment according to the grade of severity could not be quoted, because there have been no publications on this topic. Therefore, the treatment was determined based on the general opinions of professionals.
Surgical management of acute cholecystitis in the updated TG13 is fundamentally the same as in the Tokyo Guidelines 2007 (TG07), and the concept of a critical view of safety and the existence of extreme vasculobiliary injury are added in the text to call the surgeon's attention to the need to reduce the incidence of bile duct injury. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
腹腔镜胆囊切除术现在被认为是治疗急性胆囊炎的一种手术方法，只要由专家外科医生进行操作。有几条强有力的证据，如随机对照试验（RCT）和荟萃分析，支持将腹腔镜胆囊切除术引入到急性胆囊炎患者中。最新的《东京指南 2013 版》（TG13）采用问答形式，根据严重程度、时机和胆囊炎手术方式，描述了急性胆囊炎的手术治疗方法，同时使用了有关急性胆囊炎手术管理的证据。
选择了 48 篇出版物进行仔细检查，并使用这些证据研究了急性胆囊炎的手术治疗类型。与急性胆囊炎手术治疗相关的项目包括根据严重程度选择最佳的急性胆囊炎治疗方法、胆囊切除术的最佳时机、胆囊切除术的手术方式、将腹腔镜胆囊切除术转为开腹手术的最佳时机以及腹腔镜胆囊切除术的并发症。
有 8 项 RCT 和 4 项荟萃分析涉及胆囊切除术的最佳时机。结果发现，入院后尽早进行胆囊切除术更为理想。有 3 项 RCT 和 2 项荟萃分析涉及手术方式，结论是腹腔镜胆囊切除术优于开腹手术。关于根据严重程度进行手术治疗的文献无法引用，因为目前尚无这方面的出版物。因此，根据专业人员的普遍意见确定了治疗方法。
《东京指南 2013 版》中急性胆囊炎的手术治疗与《东京指南 2007 版》（TG07）基本相同，并在文本中添加了安全关键视野的概念和极端的血管胆道损伤的存在，以提醒外科医生注意减少胆管损伤的发生率。可通过 http://www.jshbps.jp/en/guideline/tg13.html 查看 TG13 的全文和移动应用程序。
