Iwashita Yukio, Ohyama Tetsuji, Honda Goro, Hibi Taizo, Yoshida Masahiro, Miura Fumihiko, Takada Tadahiro, Han Ho-Seong, Hwang Tsann-Long, Shinya Satoshi, Suzuki Kenji, Umezawa Akiko, Yoon Yoo-Seok, Choi In-Seok, Huang Wayne Shih-Wei, Chen Kuo-Hsin, Watanabe Manabu, Abe Yuta, Misawa Takeyuki, Nagakawa Yuichi, Yoon Dong-Sup, Jang Jin-Young, Yu Hee Chul, Ahn Keun Soo, Kim Song Cheol, Song In Sang, Kim Ji Hoon, Yun Sung Su, Choi Seong Ho, Jan Yi-Yin, Sheen-Chen Shyr-Ming, Shan Yan-Shen, Ker Chen-Guo, Chan De-Chuan, Lee King-Teh, Toyota Naoyuki, Higuchi Ryota, Nakamura Yoshiharu, Mizuguchi Yoshiaki, Takeda Yutaka, Ito Masahiro, Norimizu Shinji, Yamada Shigetoshi, Matsumura Naoki, Shindoh Junichi, Sunagawa Hiroki, Hasegawa Hiroshi, Rikiyama Toshiki, Sata Naohiro, Kano Nobuyasu, Kitano Seigo, Tokumura Hiromi, Yamashita Yuichi, Watanabe Goro, Nakagawa Kunitoshi, Kimura Taizo, Yamakawa Tatsuo, Wakabayashi Go, Endo Itaru, Miyazaki Masaru, Yamamoto Masakazu
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
Department of Clinical Statistics and Data Management, Oita University Faculty of Medicine, Oita, Japan.
J Hepatobiliary Pancreat Sci. 2016 Sep;23(9):533-47. doi: 10.1002/jhbp.375. Epub 2016 Sep 5.
Serious complications continue to occur in laparoscopic cholecystectomy (LC). The commonly used indicators of surgical difficulty such as the duration of surgery are insufficient because they are surgeon and institution dependent. We aimed to identify appropriate indicators of surgical difficulty during LC.
A total of 26 Japanese expert LC surgeons discussed using the nominal group technique (NGT) to generate a list of intraoperative findings that contribute to surgical difficulty. Thereafter, a survey was circulated to 61 experts in Japan, Korea, and Taiwan. The questionnaire addressed LC experience, surgical strategy, and perceptions of 30 intraoperative findings listed by the NGT.
The response rate of the survey was 100%. There was a statistically significant difference among nations regarding the duration of surgery and adoption rate of safety measures and recognition of landmarks. The criteria for conversion to an open or subtotal cholecystectomy were at the discretion of each surgeon. In contrast, perceptions of the impact of 30 intraoperative findings on surgical difficulty (categorized by factors related to inflammation and additional findings of the gallbladder and other intra-abdominal factors) were consistent among surgeons.
Intraoperative findings are objective and considered to be appropriate indicators of surgical difficulty during LC.
腹腔镜胆囊切除术（LC）中仍会出现严重并发症。常用的手术难度指标，如手术时长，并不充分，因为它们依赖于外科医生和医疗机构。我们旨在确定LC手术难度的合适指标。
26名日本LC专家外科医生讨论采用名义群体技术（NGT）来生成一份导致手术难度增加的术中发现清单。此后，向日本、韩国和台湾的61名专家进行了一项调查。问卷涉及LC经验、手术策略以及对NGT列出的30项术中发现的看法。
调查的回复率为100%。在手术时长、安全措施采用率和解剖标志识别方面，各国之间存在统计学显著差异。转为开腹或次全胆囊切除术的标准由每位外科医生自行决定。相比之下，外科医生对30项术中发现对手术难度的影响（按与炎症相关的因素、胆囊的额外发现以及其他腹腔内因素分类）的看法是一致的。
术中发现是客观的，被认为是LC手术难度的合适指标。
