Clinical evaluation of a surgical difficulty score for laparoscopic cholecystectomy for acute cholecystitis proposed in the Tokyo Guidelines 2018

医学 腹腔镜胆囊切除术 失血 急性胆囊炎 计分系统 胆囊切除术 胆囊炎 外科 胆囊
作者
Noriyuki Egawa,Atsushi Miyoshi,Tatsuya Manabe,Eiji Sadashima,Hiroki Koga,Hirofumi Sato,Osamu Ikeda,Toshiya Tanaka,Kenji Kono,Hirokazu Noshiro
出处
期刊:Journal of Hepato-biliary-pancreatic Sciences [Wiley]
卷期号:30 (5): 625-632 被引量:3
标识
DOI:10.1002/jhbp.1258
摘要

We evaluated the difficulty score of laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) proposed in the Tokyo guidelines 2018 (TG18) and analyzed the most appropriate scoring method.We reviewed 127 patients who underwent LC for AC from January 2018 to March 2022. According to TG18, surgical difficulty was scored for five categories consisting of 25 intraoperative findings. The median, highest, and mean score of the five categories were analyzed for their association with surgical outcomes.The difficulty score distribution (0/1/2/3/4/5/6) was as follows: median (8/34/43/30/12/0/0), highest (1/1/32/42/36/15/0) and mean (19/49/49/10/0/0/0). In all three scoring methods, higher difficulty scores were significantly correlated with longer operative time, more blood loss, and higher occurrence of subtotal cholecystectomy in trend tests. The areas under the curve (AUCs) for prediction of prolonged operative time minutes and increased blood loss were similar in all three scoring methods. For conversion to subtotal cholecystectomy, the AUC was significantly better for the highest than median and mean score (p = .015 and p = .002, respectively).The difficulty score in TG18 appropriately reflects the surgical difficulty of LC for AC. The median, highest, and mean scores of the five categories are all available, and the highest scores are simple and versatile.
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