Bekki Tomoaki, Abe Tomoyuki, Amano Hironobu, Hanada Keiji, Kobayashi Tsuyoshi, Noriyuki Toshio, Ohdan Hideki, Nakahara Masahiro
Department of Surgery, Onomichi General Hospital, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Asian J Endosc Surg. 2021 Jan;14(1):14-20. doi: 10.1111/ases.12801. Epub 2020 Apr 13.
The revised Tokyo guideline 2018 (TG18) recommends early laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC) who satisfy the Charlson Comorbidity Index criteria and the ASA Physical Status Classification (ASA-PS). Our study aims to determine the efficacy of the TG18 treatment strategy.
We enrolled 324 patients who had been diagnosed with AC according to the TG18 and who underwent cholecystectomy between 2010 and 2018. Perioperative variables and surgical outcomes were analyzed according to the TG18 treatment strategy and severity grading.
The Charlson Comorbidity Index and ASA-PS scores were significantly higher in patients with Grade II and Grade III AC than in those with Grade I AC. In patients with a higher severity grading, LC failed, necessitating blood transfusion and bailout surgery. Among patients treated by the TG18 strategy were a higher proportion with Grade I or II AC; their ASA-PS scores were significantly lower than patients with Grade III AC. Compared to patients not treated by the TG18 strategy, this group demonstrated significant differences in the achievement of LC, bailout surgery, postoperative hospital stays, and 90-day mortality rates. Intraoperative blood loss and blood transfusion were significantly higher in those not treated by the TG18 strategy.
Our study shows that the TG18 treatment strategy is well-designed and efficacious. Given the high rate of blood transfusion and conversion surgery in treatment strategies other that TG18, special attention should be paid when selecting the optimal treatment strategy.
修订后的《2018年东京指南》（TG18）建议，对于符合查尔森合并症指数标准和美国麻醉医师协会身体状况分类（ASA-PS）的急性胆囊炎（AC）患者，应尽早进行腹腔镜胆囊切除术（LC）。我们的研究旨在确定TG18治疗策略的疗效。
我们纳入了324例根据TG18诊断为AC且在2010年至2018年间接受胆囊切除术的患者。根据TG18治疗策略和严重程度分级分析围手术期变量和手术结果。
II级和III级AC患者的查尔森合并症指数和ASA-PS评分显著高于I级AC患者。在严重程度分级较高的患者中，LC失败，需要输血和补救手术。在接受TG18策略治疗的患者中，I级或II级AC患者的比例更高；他们的ASA-PS评分显著低于III级AC患者。与未采用TG18策略治疗的患者相比，该组在LC完成情况、补救手术、术后住院时间和90天死亡率方面存在显著差异。未采用TG18策略治疗的患者术中失血量和输血量显著更高。
我们的研究表明，TG18治疗策略设计合理且有效。鉴于TG18以外的治疗策略中输血和中转手术的发生率较高，在选择最佳治疗策略时应特别注意。
