Washington University School of Medicine, St. Louis, MO.
Rush University Medical Center, Chicago IL.
Ann Surg. 2020 Jul;272(1):3-23. doi: 10.1097/SLA.0000000000003791.
BDI is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI.
Literature reviews were conducted for 18 key questions across 6 broad topics around cholecystectomy directed by a steering group and subject experts from 5 surgical societies (Society of Gastrointestinal and Endoscopic Surgeons, Americas Hepato-Pancreato-Biliary Association, International Hepato-Pancreato-Biliary Association, Society for Surgery of the Alimentary Tract, and European Association for Endoscopic Surgery). Evidence-based recommendations were formulated using the grading of recommendations assessment, development, and evaluation methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus.
Consensus was reached on 17 of 18 questions by the guideline development group and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team.
These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.
BDI 是腹腔镜胆囊切除术最常见的严重并发症。为了解决这个问题，举行了一次多学会共识会议，以制定基于证据的安全胆囊切除术和预防 BDI 的建议。
由一个指导小组和来自 5 个外科协会（胃肠内镜外科学会、美国肝胆胰外科学会、国际肝胆胰外科学会、消化道外科学会和欧洲内镜外科学会）的主题专家对 6 个广泛主题的 18 个关键问题进行文献回顾。使用分级评估、制定和评价方法制定基于证据的建议。当不能提出基于证据的建议时，记录专家意见。还记录了一些关于未来研究的建议。这些建议在 2018 年 10 月的共识会议上提出，并由一个由 25 名专家组成的国际小组进行投票，超过 80%的一致意见被认为是共识。
指南制定小组和专家小组就 18 个问题中的 17 个达成共识，与会者的参与度很高。由于证据确定性低，大多数建议都是有条件的。强烈建议在以下情况下使用术中胆道成像：解剖结构不确定或怀疑胆道损伤；以及（2）将确诊或疑似 BDI 的患者转介给有经验的外科医生/多学科肝胆团队。
这些共识建议应为外科医生、培训计划、医院和专业协会提供指导，以制定策略，这些策略有可能减少 BDI 并对患者的结果产生积极影响。根据这些建议制定临床和教育研究计划，可能会进一步提高接受胆囊切除术患者的手术护理质量。
