Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
Westmead Clinical School, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2021 Jul;91(7-8):1358-1363. doi: 10.1111/ans.16761. Epub 2021 Apr 1.
Throughout the COVID-19 pandemic, there has been worldwide debate regarding whether open surgery should be performed in preference to laparoscopic surgery due to the theoretical higher risk of viral aerosolization by the release of pneumoperitoneum. We aimed to assess the consistency of national and international surgical society recommendations regarding the choice of surgical approach; assess the quality of evidence of viral emission in surgical aerosol; and assess the quality of evidence comparing aerosol generation by different surgical energy devices.
A systematic review of PubMed, Medline, Embase and Cochrane databases was performed. Three search strategies were employed. Twenty-eight studies were included in the final analysis and quality appraised. Confidence in review findings was assessed using the GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) tool.
Worldwide recommendations regarding open versus laparoscopic surgery are consistent, with a majority recommending that surgical approach is decided on a case-by-case, risk minimization approach. There is limited, low-quality evidence that viral particles can be emitted in surgical aerosol. There is a paucity of literature on the quantity of aerosol produced by different surgical energy devices, and no evidence to support the use of certain surgical instruments to minimize aerosol production.
There is considerable consistency among worldwide recommendations regarding the choice of surgical approach, although the evidence base is lacking. To inform clinical recommendations, further research examining viral emission, transmission, infectivity and amount of surgical aerosol produced is required.
在整个 COVID-19 大流行期间，由于理论上通过释放气腹会增加病毒气溶胶化的风险，全球范围内一直存在着关于应优先选择开腹手术还是腹腔镜手术的争论。我们旨在评估关于手术方式选择的国家和国际外科协会建议的一致性；评估手术气溶胶中病毒排放的证据质量；并评估不同手术能量设备产生气溶胶的证据质量。
对 PubMed、Medline、Embase 和 Cochrane 数据库进行了系统评价。采用了三种搜索策略。最终分析和质量评估纳入了 28 项研究。使用 GRADE-CERQual（对定性研究证据的信心）工具评估了对审查结果的信心。
全球范围内关于开腹手术与腹腔镜手术的建议是一致的，大多数建议根据具体情况采用风险最小化的方法来决定手术方式。有有限的低质量证据表明病毒颗粒可以在手术气溶胶中释放。关于不同手术能量设备产生的气溶胶量的文献很少，也没有证据支持使用某些手术器械来减少气溶胶的产生。
尽管证据基础不足，但全球范围内关于手术方式选择的建议存在相当大的一致性。为了为临床建议提供信息，需要进一步研究病毒排放、传播、传染性和产生的手术气溶胶量。
