Pereira Jorge, Bass Gary A, Mariani Diego, Dumbrava Bogdan D, Casamassima Andrea, da Silva António Rodrigues, Pinheiro Luis, Martinez-Casas Isidro, Zago Mauro
Division of Hepatobiliary Surgery, Department of General Surgery, Hospital São Teotónio, Viseu, Portugal.
Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland.
Eur J Trauma Emerg Surg. 2020 Feb;46(1):173-183. doi: 10.1007/s00068-019-01197-z. Epub 2019 Aug 21.
Acute cholecystitis (AC), frequently responsible for presentation to the emergency department, requires expedient diagnosis and definitive treatment by a general surgeon. Ultrasonography, usually performed by radiology technicians and reported by radiologists, is the first-line imaging study for the assessment of AC. Targeted point-of-care ultrasound (POCUS), particularly in the hands of the treating surgeon, may represent an evolution in surgical decision-making and may expedite care, reducing morbidity and cost.
This consensus guideline was written under the auspices of the European Society of Trauma and Emergency Surgery (ESTES) by the POCUS working group. A systematic literature search identified relevant papers on the diagnosis and treatment of AC. Literature was critically-appraised according to the GRADE evidence-based guideline development method. Following a consensus conference at the European Congress of Trauma & Emergency Surgery (Valencia, Spain, May 2018), final recommendations were approved by the working group, using a modified e-Delphi process, and taking into account the level of evidence of the conclusion.
We strongly recommend the use of ultrasound as the first-line imaging investigation for the diagnosis of AC; specifically, we recommend that POCUS may be adopted as the primary imaging adjunct to surgeon-performed assessment of the patient with suspected AC. In line with the Tokyo guidelines, we strongly recommend Murphy's sign, in conjunction with the presence of gallstones and/or wall thickening as diagnostic of AC in the correct clinical context. We conditionally recommend US as a preoperative predictor of difficulty of cholecystectomy. There is insufficient evidence to recommend contrast-enhanced ultrasound or Doppler ultrasonography in the diagnosis of AC. We conditionally recommend the use of ultrasound to guide percutaneous cholecystostomy placement by appropriately-trained practitioners.
Surgeons have recently embraced POCUS to expedite diagnosis of AC and provide rapid decision-making and early treatment, streamlining the patient pathway and thereby reducing costs and morbidity.
急性胆囊炎（AC）常导致患者前往急诊科就诊，需要普通外科医生进行快速诊断和明确治疗。超声检查通常由放射技术人员操作并由放射科医生报告，是评估AC的一线影像学检查。有针对性的床旁超声检查（POCUS），特别是在主刀医生手中，可能代表了手术决策的一种演变，并可能加快治疗速度，降低发病率和成本。
本共识指南由POCUS工作组在欧洲创伤与急诊外科学会（ESTES）的支持下编写。系统的文献检索确定了有关AC诊断和治疗的相关论文。根据GRADE循证指南制定方法对文献进行严格评估。在欧洲创伤与急诊外科学会大会（2018年5月，西班牙巴伦西亚）召开共识会议后，工作组采用改良的电子德尔菲法，并考虑结论的证据水平，批准了最终建议。
我们强烈推荐使用超声作为诊断AC的一线影像学检查；具体而言，我们建议POCUS可作为外科医生对疑似AC患者进行评估的主要影像学辅助手段。根据东京指南，我们强烈推荐在正确的临床背景下，将墨菲氏征与胆结石和/或胆囊壁增厚同时出现作为AC的诊断依据。我们有条件地推荐超声作为胆囊切除术难度的术前预测指标。在AC的诊断中，没有足够的证据推荐使用超声造影或多普勒超声检查。我们有条件地建议由经过适当培训的人员使用超声引导经皮胆囊造瘘术的放置。
外科医生最近采用了POCUS来加快AC的诊断，提供快速决策和早期治疗，简化患者就医流程，从而降低成本和发病率。
