1Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland.
Papa Giovanni Hospital, Bergamo, Italy.
World J Emerg Surg. 2019 Mar 14;14:12. doi: 10.1186/s13017-019-0230-9. eCollection 2019.
Laparoscopic cholecystectomy, the gold-standard approach for cholecystectomy, has surprisingly variable outcomes and conversion rates. Only recently has operative grading been reported to define disease severity and few have been validated. This multicentre, multinational study assessed an operative scoring system to assess its ability to predict the need for conversion from laparoscopic to open cholecystectomy.
A prospective, web-based, ethically approved study was established by WSES with a 10-point gallbladder operative scoring system; enrolling patients undergoing elective or emergency laparoscopic cholecystectomy between January 2016 and December 2017. Gallbladder surgery was considered easy if the G10 score < 2, moderate (2 ≦ 4), difficult (5 ≦ 7) and extreme (8 ≦ 10). Demographics about the patients, surgeons and operative procedures, use of cholangiography and conversion rates were recorded.
Five hundred four patients, mean age 53.5 (range 18-89), were enrolled by 55 surgeons in 16 countries. Surgery was performed by consultants in 70% and was elective in (56%) with a mean operative time of 78.7 min (range 15-400). The mean G10 score was 3.21, with 22% deemed to have difficult or extreme surgical gallbladders, and 71/504 patients were converted. The G10 score was 2.98 in those completed laparoscopically and 4.65 in the 71/504 (14%) converted. ( < 0.0001; AUC 0.772 (CI 0.719-0.825). The optimal cut-off point of 0.067 (score of 3) was identified in G10 vs conversion to open cholecystectomy. Conversion occurred in 33% of patients with G10 scores of ≥ 5. The four variables statistically predictive of conversion were GB appearance-completely buried GB, impacted stone, bile or pus outside GB and fistula.
The G10 operative scores provide simple grading of operative cholecystectomy and are predictive of the need to convert to open cholecystectomy. Broader adaptation and validation may provide a benchmark to understand and improve care and afford more standardisation in global comparisons of care for cholecystectomy.
腹腔镜胆囊切除术是胆囊切除术的金标准，但术后结果和中转开腹率差异很大。直到最近，人们才开始采用手术分级来定义疾病严重程度，但这种方法的验证还很少。这项多中心、多国研究评估了一种手术评分系统，以评估其预测从腹腔镜转为开腹胆囊切除术的能力。
WSES 建立了一项前瞻性、基于网络、符合伦理的研究，采用 10 分胆囊手术评分系统；纳入 2016 年 1 月至 2017 年 12 月期间行择期或急诊腹腔镜胆囊切除术的患者。如果 G10 评分<2，则胆囊手术被认为简单；如果 2≦G10≦4，则为中度；如果 5≦G10≦7，则为困难；如果 8≦G10≦10，则为复杂。记录患者、外科医生和手术过程、胆管造影的使用情况以及中转开腹率等信息。
共纳入 504 名患者，平均年龄 53.5 岁（18-89 岁），由 55 名外科医生在 16 个国家进行手术。70%的手术由顾问医生完成，56%为择期手术，平均手术时间为 78.7 分钟（15-400 分钟）。G10 的平均评分为 3.21，22%的患者被认为有困难或复杂的手术胆囊，71/504 名患者中转开腹。G10 评分在腹腔镜下完成手术的患者中为 2.98，在 71/504 名中转开腹的患者中为 4.65（ < 0.0001；AUC 0.772（CI 0.719-0.825）。G10 评分与中转开腹之间的最佳截断值为 0.067（评分 3）。G10 评分≥5 的患者中转开腹的比例为 33%。有统计学意义的四个预测中转开腹的变量为胆囊外观（完全埋入胆囊、嵌顿结石、胆囊外胆汁或脓液和瘘管）。
G10 手术评分可简单分级手术难度，预测是否需要中转开腹。更广泛的应用和验证可能提供一个基准，以了解和改善护理，并为全球胆囊切除术护理的比较提供更多的标准化。
