腹腔镜肝切除术推荐意见：在盛冈召开的第二届国际共识会议报告
Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka.
机构信息
*Iwate Medical University, Morioka, Japan †Hepatobiliary Center-Paul Brousse Hospital, Villejuif, France ‡University of Pittsburgh, Pittsburgh, PA §Tulane Transplant Institute, Tulane Medical Center, and Louisiana State University and Medical Center, New Orleans, LA ¶Toho University School of Medicine, Tokyo, Japan ‖Seoul National University Bundang Hospital, Seongnam-si, South Korea **Mayo Clinic, Florida, FL ††Royal Brisbane Hospital, Queensland, Australia ‡‡Tokyo Medical and Dental University, Tokyo, Japan §§Beaumont Health System, Michigan, MI ¶¶University of Pittsburgh Medical Center, Pittsburgh, PA ‖‖Beaujon Hospital, Clichy, France ***Hospital Sirio Libanês, Sao Paulo, Brazil †††Institute Mutualiste Montsouris, France ‡‡‡Ghent University Hospital Medical School, Ghent, Belgium §§§Institut Hospitalo-Universitaire, Strasbourg, France ¶¶¶Maastricht University Medical Center, Maastricht, Netherlands ‖‖‖Pitie-Salpetriere Hospital, Paris, France ****Southampton University Hospital Trust, Hampshire, UK ††††Loreto Nuovo Hospital, Napoli, Italy ‡‡‡‡Sungkyunkwan University, Seoul, South Korea §§§§University of Oslo, Oslo, Norway ¶¶¶¶Yonsei University College of Medicine, Seoul, South Korea ‖‖‖‖San Raffaele Hospital, Milano, Italy *****Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China †††††University of Toronto, Ontario, Canada ‡‡‡‡‡Far-Eastern Memorial Hospital, New Taipei City, Taiwan §§§§§Klinikum Karlsruhe, Karlsruhe, Germany ¶¶¶¶¶Fujita Health University, Aichi, Japan ‖‖‖‖‖Pamela Youde Nethersole Eastern Hospital, Hong Kong, China ******University of Sao Paulo Medical School, Sao Paulo, Brazil ††††††Hospital Italiano Buenos Aires, Argentina ‡‡‡‡‡‡Tongji Hospital, HuaZhong University of Science & Technology, Wuhan, China §§§§§§Paris-South University Hospital, Orsay, France ¶¶¶¶¶¶Memorial Sloan-Kett
出版信息
Ann Surg. 2015 Apr;261(4):619-29. doi: 10.1097/SLA.0000000000001184.
The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve.
腹腔镜肝切除术的应用正在迅速增加。2014 年 10 月 4 日至 6 日，第二届国际腹腔镜肝切除会议（LLR）在日本盛冈举行，旨在评估腹腔镜肝手术的现状，并提供建议以促进其未来发展。会议共提出了 17 个问题。前 7 个问题集中在反映 LLR 益处和风险的结果上。这些问题采用了苏黎世-丹麦共识会议模式，由 9 名评审员权衡文献和专家意见，使用 GRADE 和一系列对照物评估 LLR 结果。评审团还根据 IDEAL 的 Balliol 分类对 LLR 进行了分级。评审团得出结论，MINOR LLR 已成为标准实践（IDEAL 3），而 MAJOR 肝切除术仍处于探索阶段的创新手术（IDEAL 2b）。建议继续谨慎地开展 MAJOR LLR。通过 GRADE 评估，所有可供审查的证据质量均较低，因此建议开展更高质量的评估性研究。最后 10 个问题集中在技术问题上，建议是基于文献回顾和专家小组意见提出的。建议涉及术前评估、出血控制、横断方法、解剖方法和设备。专家和评审团都认识到，由于学习曲线陡峭，对于有兴趣进行主要腹腔镜 LLR 的人来说，需要建立一个正式的教育结构。
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