困境中的机遇：日本-韩国-台湾专家关于腹腔镜胆囊切除术手术难度的德尔菲共识
An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy.
作者信息
Iwashita Yukio, Hibi Taizo, Ohyama Tetsuji, Honda Goro, 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, Shan Yan-Shen, Ker Chen-Guo, Chan De-Chuan, Wu Cheng-Chung, 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, Gocho Takeshi, Hasegawa Hiroshi, Rikiyama Toshiki, Sata Naohiro, Kano Nobuyasu, Kitano Seigo, Tokumura Hiromi, Yamashita Yuichi, Watanabe Goro, Nakagawa Kunitoshi, Kimura Taizo, Yamakawa Tatsuo, Wakabayashi Go, Mori Rintaro, Endo Itaru, Miyazaki Masaru, Yamamoto Masakazu
机构信息
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
出版信息
J Hepatobiliary Pancreat Sci. 2017 Apr;24(4):191-198. doi: 10.1002/jhbp.440. Epub 2017 Mar 19.
BACKGROUND
We previously identified 25 intraoperative findings during laparoscopic cholecystectomy (LC) as potential indicators of surgical difficulty per nominal group technique. This study aimed to build a consensus among expert LC surgeons on the impact of each item on surgical difficulty.
METHODS
Surgeons from Japan, Korea, and Taiwan (n = 554) participated in a Delphi process and graded the 25 items on a seven-stage scale (range, 0-6). Consensus was defined as (1) the interquartile range (IQR) of overall responses ≤2 and (2) ≥66% of the responses concentrated within a median ± 1 after stratification by workplace and LC experience level.
RESULTS
Response rates for the first and the second-round Delphi were 92.6% and 90.3%, respectively. Final consensus was reached for all the 25 items. 'Diffuse scarring in the Calot's triangle area' in the 'Factors related to inflammation of the gallbladder' category had the strongest impact on surgical difficulty (median, 5; IQR, 1). Surgeons agreed that the surgical difficulty increases as more fibrotic change and scarring develop. The median point for each item was set as the difficulty score.
CONCLUSIONS
A Delphi consensus was reached among expert LC surgeons on the impact of intraoperative findings on surgical difficulty.
背景
我们之前通过名义组技术确定了腹腔镜胆囊切除术（LC）期间的25项术中发现，作为手术难度的潜在指标。本研究旨在就每项指标对手术难度的影响在LC外科专家中达成共识。
方法
来自日本、韩国和台湾的外科医生（n = 554）参与了德尔菲法，并对这25项指标进行了七阶段评分（范围为0 - 6）。共识的定义为：（1）总体反应的四分位间距（IQR）≤2；（2）按工作场所和LC经验水平分层后，≥66%的反应集中在中位数±1范围内。
结果
第一轮和第二轮德尔菲法的回复率分别为92.6%和90.3%。所有25项指标均达成了最终共识。“胆囊炎症相关因素”类别中的“胆囊三角区弥漫性瘢痕形成”对手术难度的影响最大（中位数为5；IQR为1）。外科医生一致认为，纤维化改变和瘢痕形成越多，手术难度越大。每项指标的中位数点被设定为难度得分。
结论
LC外科专家就术中发现对手术难度的影响达成了德尔菲共识。
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